Fofi Claudia, Festuccia Francescaromana, Barberi Simona, Apponi Francesca, Chiacchiararelli Laura, Scopinaro Francesco, Punzo Giorgio, Menè Paolo
Nephrology Unit, Sant'Andrea Hospital, Second School of Medicine, Sapienza University of Rome, Via di Grottarossa 1035-39, Rome, Italy.
Int J Artif Organs. 2013 Jun 25;36(6):439-43. doi: 10.5301/ijao.5000192. Epub 2013 May 8.
Thyroid malignancies can be treated by surgery followed by ablation of the remnant tissue with 131I. As iodide removal from the body occurs by renal extraction, in patients suffering from end-stage renal disease it is necessary to properly evaluate both timing and method of the extracorporeal treatment.
We present two patients on regular hemodialysis, admitted in isolation to the Nuclear Medicine Department and treated with 131I for thyroid carcinoma diagnosed during the check-up for transplantation. Both patients underwent two hemodialysis sessions with a portable machine for CRRT (continuous renal replacement therapy), 24 and 48 hours after the administration of 50 mCi of 131I. The nursing staff were monitored with a dosimeter. Radioactivity of the patients, dialysate and urines were measured during hemodialysis.
The greater reduction was obtained with the first dialysis, but in both patients a further, though shorter, hemodialysis at 48 hours was necessary for reaching a patient's radioactivity compatible with discharge. Radioactivity measured in the dialysate demonstrated the almost total removal of radioiodine by dialysis alone. In both patients, follow-up exams revealed a complete ablation of thyroid tissue, without signs of local recurrence. The dose of radioactivity of the dialysis staff was below allowable limits.
We conclude that a successful reduction of radioactivity, without dispersing its therapeutic efficacy, can be obtained with daily hemodialysis with a CRRT machine in patients in isolation treated with 131I. A therapeutic model is proposed.
甲状腺恶性肿瘤可通过手术治疗，随后用131I消融残余组织。由于碘通过肾脏排泄从体内清除，对于终末期肾病患者，有必要正确评估体外治疗的时机和方法。
我们报告两名定期进行血液透析的患者，他们被单独收治入核医学科，并接受131I治疗，其甲状腺癌是在移植检查期间诊断出来的。两名患者在给予50毫居里131I后的24小时和48小时，使用便携式机器进行连续肾脏替代疗法（CRRT）进行了两次血液透析。护理人员使用剂量计进行监测。在血液透析期间测量患者、透析液和尿液的放射性。
第一次透析获得了更大程度的放射性降低，但对于两名患者来说，在48小时时都需要进一步进行一次时间较短的血液透析，以使患者的放射性达到适合出院的水平。透析液中测量的放射性表明，仅通过透析就几乎完全清除了放射性碘。两名患者的随访检查均显示甲状腺组织完全消融，无局部复发迹象。透析工作人员的放射性剂量低于允许限值。
我们得出结论，对于接受131I单独治疗的隔离患者，使用CRRT机器进行每日血液透析可以成功降低放射性，同时不分散其治疗效果。我们提出了一种治疗模式。
