Cherk Martin H, Kalff Victor, Yap Kenneth S K, Bailey Michael, Topliss Duncan, Kelly Michael J
Department of Nuclear Medicine, The Alfred Hospital, Melbourne, Victoria 3004, Australia.
Clin Endocrinol (Oxf). 2008 Dec;69(6):957-62. doi: 10.1111/j.1365-2265.2008.03276.x. Epub 2008 Apr 12.
To evaluate the relationships between thyroid remnant (131)I uptake, radiation thyroiditis and remnant ablation success rate between lower (1110 MBq) and higher (3700 MBq) initial ablative (131)I dose for post-surgical ablation therapy for differentiated thyroid cancer.
Patients having post-surgical administration of 1110 MBq (68 patients) or 3700 MBq (115 patients) (131)I were retrospectively reviewed. Thyroid remnant (131)I uptake on a 48 h post-administration scan was correlated with neck symptoms experienced. Patients were classified as having insignificant, mild or severe thyroiditis based on symptoms. Absent thyroid bed (131)I uptake on a follow-up 74 MBq (131)I study was considered successful ablation.
183 patients were included. Median (131)I remnant uptake was 37 MBq. 21% (39/183) of patients developed thyroiditis. Incidence and severity of thyroiditis increased with increasing remnant (131)I activity (P <or= 0.0001). Risk of thyroiditis increased by 64% for every 37 MBq increase in remnant (131)I uptake. OR = 1.64 [1.36-1.99]. Severe thyoriditis was only seen with remnant (131)I uptake > 73 MBq. For patients treated with 1110 MBq and 3700 MBq, incidence of thyroiditis was 12% and 27% (P = 0.02) and remnant ablation success rate was 76% and 84% (P = NS), respectively. Occurrence of thyroiditis did not correlate with successful ablation.
Incidence and severity of radiation thyroiditis following (131)I remnant ablation therapy is directly related to thyroid remnant (131)I uptake. As 1110 MBq (131)I is associated with a significantly lower frequency of thyroiditis but similar remnant ablation rate to 3700 MBq, it warrants consideration for thyroid remnant ablation particularly in patients with low risk disease.
评估分化型甲状腺癌术后消融治疗中，较低初始消融碘-131剂量（1110 MBq）与较高初始消融碘-131剂量（3700 MBq）之间，甲状腺残余组织碘-131摄取、放射性甲状腺炎和残余组织消融成功率的关系。
对术后接受1110 MBq（68例患者）或3700 MBq（115例患者）碘-131治疗的患者进行回顾性研究。给药后48小时扫描时甲状腺残余组织碘-131摄取情况与所经历的颈部症状相关。根据症状将患者分为无明显甲状腺炎、轻度甲状腺炎或重度甲状腺炎。在随访的74 MBq碘-131检查中甲状腺床无碘-131摄取被视为消融成功。
纳入183例患者。碘-131残余摄取的中位数为37 MBq。21%（39/183）的患者发生了甲状腺炎。甲状腺炎的发生率和严重程度随残余碘-131活性增加而升高（P≤0.0001）。残余碘-131摄取每增加37 MBq，甲状腺炎风险增加64%。比值比=1.64[1.36 - 1.99]。仅在残余碘-131摄取>73 MBq时出现重度甲状腺炎。对于接受1110 MBq和3700 MBq治疗的患者，甲状腺炎发生率分别为12%和27%（P = 0.02），残余组织消融成功率分别为76%和84%（P = 无统计学差异）。甲状腺炎的发生与消融成功与否无关。
碘-131残余组织消融治疗后放射性甲状腺炎的发生率和严重程度与甲状腺残余组织碘-131摄取直接相关。由于1110 MBq碘-131所致甲状腺炎的发生率显著较低，但残余组织消融率与3700 MBq相似，因此尤其对于低风险疾病患者，在甲状腺残余组织消融中值得考虑使用。
