Thyroid Unit, Massachusetts General Hospital, Boston, Massachusetts 02114, USA.
Thyroid. 2012 Apr;22(4):369-76. doi: 10.1089/thy.2011.0198. Epub 2012 Mar 2.
Radioactive iodine lobe ablation (RAI-L-ABL) is a possible alternative to completion thyroidectomy (C-Tx) for follicular thyroid carcinoma (FTC), but no long-term outcome data are available after lobe ablation. We analyzed the long-term outcome of lobe ablation in a series of patients with FTC.
This was a retrospective study of patients who were treated with lobe ablation between 1983 and 2008. Of 134 patients with FTC, 37 (27.6%) had lobe ablation with (131)I (30-32 mCi) (RAI-L-ABL), 68 (50.7%) had C-Tx, and 29 (21.6%) had initial total thyroidectomy (T-Tx). The main outcomes analyzed were (131)I uptake after lobe ablation, C-Tx or T-Tx, serum thyroglobulin (Tg), serum thyroid-stimulating hormone (TSH), long-term disease-specific mortality, and disease-free survival.
After lobe ablation, radioiodine uptake was significantly lower for the RAI-L-ABL group (0.6%) than for the C-Tx group (2.0%, p<0.005) or T-Tx group (1.3%, p=0.054). Subsequent remnant ablation was performed in 12 of 37 (32%) patients in the RAI-L-ABL group, in 58 of 68 (85.3%) patients in the C-Tx group, and in 25 of 29 (86.2%) patients in the T-Tx group (p<0.01). With median follow-up of 95 months for the RAI-L-ABL group, 47 months for the C-Tx group, and 53 months for the T-Tx group, there was one death in the RAI-L-ABL group and one death in the T-Tx group. No other RAI-L-ABL patients had detectable disease, whereas patients in the C-Tx group and two patients in the T-Tx group had detectable disease (p=0.18). Long-term stimulated or suppressed Tg of <1 ng/mL were found in 87.5% of the RAI-L-ABL group (n=28), 86.3% of the C-Tx group (n=57), and 77.8% of the T-Tx group (n=21). Tg was detectable in 40.6% of the RAI-L-ABL group compared to 13.8% of C-Tx and 28.6% of T-Tx groups (p<0.05, between groups).
RAI-L-ABL, C-Tx, and T-Tx are equally effective in achieving serum TSH concentrations of >25 mIU/L and preparing patients for conventional (131)I treatment and whole body scanning with similar long-term outcomes. However, persistent measurable Tg (range 0.2-2.2 ng/mL) is more common after RAI-L-ABL.
放射性碘叶切除术（RAI-L-ABL）可能是滤泡状甲状腺癌（FTC）甲状腺全切术（C-Tx）的替代方案，但叶切除术后尚无长期结果数据。我们分析了一系列 FTC 患者行叶切除术后的长期结果。
这是一项回顾性研究，纳入了 1983 年至 2008 年间接受叶切除术治疗的患者。在 134 例 FTC 患者中，37 例（27.6%）接受放射性碘叶切除术（131）I（30-32 mCi）（RAI-L-ABL），68 例（50.7%）接受 C-Tx，29 例（21.6%）接受初始甲状腺全切除术（T-Tx）。主要分析的结果包括叶切除术后 131I 摄取、C-Tx 或 T-Tx、血清甲状腺球蛋白（Tg）、血清促甲状腺激素（TSH）、疾病特异性死亡率和无病生存率。
叶切除术后，RAI-L-ABL 组（0.6%）的放射性碘摄取明显低于 C-Tx 组（2.0%，p<0.005）或 T-Tx 组（1.3%，p=0.054）。随后，在 RAI-L-ABL 组的 12 例（32%）患者中进行了残余消融，在 C-Tx 组的 58 例（85.3%）患者中进行了残余消融，在 T-Tx 组的 25 例（86.2%）患者中进行了残余消融（p<0.01）。RAI-L-ABL 组的中位随访时间为 95 个月，C-Tx 组为 47 个月，T-Tx 组为 53 个月。在 RAI-L-ABL 组中有 1 例死亡，在 T-Tx 组中有 1 例死亡。RAI-L-ABL 组无患者发现疾病，而 C-Tx 组和 T-Tx 组各有 1 例患者发现疾病（p=0.18）。在 RAI-L-ABL 组中，87.5%（28 例）、C-Tx 组中 86.3%（57 例）和 T-Tx 组中 77.8%（21 例）的患者血清 Tg 刺激或抑制后<1ng/mL。RAI-L-ABL 组中有 40.6%的患者 Tg 可检测到，而 C-Tx 组为 13.8%，T-Tx 组为 28.6%（p<0.05，组间）。
RAI-L-ABL、C-Tx 和 T-Tx 在实现血清 TSH 浓度>25 mIU/L 和使患者为常规（131）I 治疗和全身扫描做好准备方面同样有效，且长期结果相似。然而，RAI-L-ABL 后持续可检测到的 Tg（范围 0.2-2.2ng/mL）更为常见。
