Department of Endocrinology, University of Pisa, Via Paradisa 2, Pisa, Italy.
J Endocrinol Invest. 2012;35(6 Suppl):16-20.
Due to the growing incidence of differentiated thyroid carcinoma (DTC) and in particular of small papillary thyroid cancer observed in the last few decades, the indications, the activity of radioiodine (131I) to be administered, and the efficacy of post surgical thyroid 131I remnant ablation (RRA) have been widely discussed. In the last 10 years, the use of recombinant human TSH (rhTSH) or thyroid hormone withdrawal (THW) to stimulate the 131I remnant uptake has also interested many authors. The general agreement is that small (≤1 cm) intrathyroidal unifocal DTC with a favorable histology and no node metastases should not be submitted to RRA because of the low risk of relapse and cancer specific mortality. Conversely, RRA is indicated in patients with a higher risk level since it seems to reduce recurrence rates and mortality. The recent demonstration that the RRA preparation with rhTSH is as effective as THW using either high (100 mCi) or low (30 mCi) 131I activities suggests that rhTSH preparation and low activity of 131I should be considered as the standard of care for both low- and intermediate-risk DTC patients in the near future. Moreover, the use of low 131I activities and rhTSH reduces whole body radiation exposure and improves the quality of life which are very important advantages for DTC patients.
由于过去几十年间分化型甲状腺癌（DTC），特别是甲状腺微小乳头状癌发病率的增加，放射性碘（131I）的应用指征、用量和甲状腺术后 131I 残留组织清除术（RRA）的疗效已得到广泛讨论。在过去的 10 年中，使用重组人促甲状腺激素（rhTSH）或甲状腺激素抑制（THW）来刺激 131I 摄取也引起了许多作者的兴趣。一般认为，对于具有良好组织学且无淋巴结转移的≤1cm 的甲状腺内单发 DTC，由于复发和癌症特异性死亡率低，不应进行 RRA。相反，对于风险较高的患者，RRA 是指征，因为它似乎可以降低复发率和死亡率。最近的研究表明，rhTSH 准备与 THW 相比，无论是使用高（100 mCi）还是低（30 mCi）131I 活性，RRA 准备都是有效的，这表明 rhTSH 准备和低活性 131I 应被视为低危和中危 DTC 患者的标准治疗方案在不久的将来。此外，低 131I 活性和 rhTSH 的使用降低了全身辐射暴露，提高了生活质量，这对 DTC 患者非常重要。
