Prpić Marin, Jukić Tomislav, Murgić Jure, Borić Marta, Stanicić Josip, Kusić Zvonko
University of Zagreb, "Sestre milosrdnice" University Hospital Center, Department of Oncology and Nuclear Medicine, Zagreb, Croatia.
Coll Antropol. 2011 Jun;35(2):587-94.
In the management of large number of patients with differentiated thyroid cancer, the radioactive iodine (131-I) administration plays an important role. The guidelines of numerous international and national medical societies regarding the issue of postoperative 131-I administration have been published and updated in the last few years. The guidelines differ in the shape and content, and contain some specific features. The different methods for evaluation and analysis of clinical evidence level and resulting grades of recommendations have been used in line with the very guidelines. The postoperative 131-I administration refers to the radioiodine ablation as a form of adjuvant treatment and radioiodine therapy in the management of patients with recurrent cancer, persistent disease and regional or distant metastases. According to the indications for the postoperative 131-I administration, the patients could be divided into the three risk groups: the very low risk group in which there is no indication for the postoperative 131-I administration, the low risk group in which the indication could be considered, and the high risk group in which there is a clear indication for the 131-I administration. The different criteria for distribution of patients into these three groups are expressed in a certain guidelines. There are different opinions about the necessary dosage of 131-I for the efficient ablation in the low risk group. Moreover, the opinions are also divided regarding the conduction of postoperative (preablative or pretherapeutic) scintigraphy with 131-I. As regards the instructions on preparation of patients for the radioiodine ablation and therapy, all the guidelines recommend the low iodine diet and endogenous or exogenous stimulation of TSH. The endogenous stimulation is accomplished by the withdrawal of thyroid hormones, whereas the recombinant human TSH (rhTSH) is used for exogenous stimulation. For conducting the therapy with 131-I the level of TSH has to be > 25-30 mU/L.
在大量分化型甲状腺癌患者的管理中，放射性碘（131-I）给药起着重要作用。在过去几年中，众多国际和国家医学协会已发布并更新了关于术后131-I给药问题的指南。这些指南在形式和内容上有所不同，并包含一些特定特征。根据这些指南采用了不同的临床证据水平评估和分析方法以及由此得出的推荐等级。术后131-I给药是指放射性碘消融作为辅助治疗的一种形式以及用于复发性癌症、持续性疾病和区域或远处转移患者管理中的放射性碘治疗。根据术后131-I给药的适应证，患者可分为三个风险组：术后131-I给药无适应证的极低风险组、可考虑适应证的低风险组以及有明确131-I给药适应证的高风险组。在某些指南中表达了将患者分为这三组的不同标准。对于低风险组有效消融所需的131-I剂量存在不同意见。此外，对于是否进行术后（消融前或治疗前）131-I闪烁扫描也存在分歧。关于患者放射性碘消融和治疗的准备说明，所有指南都推荐低碘饮食以及内源性或外源性促甲状腺激素（TSH）刺激。内源性刺激通过停用甲状腺激素来实现，而重组人TSH（rhTSH）用于外源性刺激。为了进行131-I治疗，TSH水平必须>25 - 30 mU/L。
