Comtois R, Thériault C, Del Vecchio P
Department of Medicine, Notre-Dame Hospital, University of Montreal, Quebec, Canada.
J Nucl Med. 1993 Nov;34(11):1927-30.
It is customary to ablate residual tissue after near-total thyroidectomy for thyroid carcinoma by administering 131I. A recent trend has been to use lower 131I doses. This study was designed to assess the efficacy of thyroid ablation by 1110 MBq of 131I (30 mCi) in patients who had near-total thyroidectomy for papillary, mixed or follicular thyroid carcinoma. Four months after surgery, a whole-body scan was done using 185 MBq (5 mCi) of 131I after withdrawal of L-thyroxine for 5-6 wk. Residual thyroid area was then measured by planimetry of the thyroid scan. Patients received ablation therapy within 5 days after scanning and one or more subsequent scans were performed 6 mo later. Forty-four patients were treated to ablate residual functional thyroid tissue. Of these, 12 (27%) had successful ablation. Total body areas (1.63 +/- 0.16 versus 1.83 +/- 0.30, p < 0.03) and residual thyroid tissue (1.4 +/- 1.4 versus 2.0 +/- 1.2 cm2, p < 0.05) were less in patients with total thyroid ablation while there was a trend for a smaller incidence of associated goiter in those patients (1/12 versus 13/32, p < 0.07). Nine of the 17 (53%) patients with a total body area less than 1.9 m2 and/or with a residual thyroid tissue less than 2.1 cm2 and/or without associated previous associated diffuse or multinodular goiter had a total thyroid ablation, while 3 of the 27 (11%) patients who did not have these characteristics had a successful therapy (p < 0.005). Our data suggest that 1110 MBq (30 mCi) of 131I can achieve total ablation of residual thyroid tissue after near-total thyroidectomy particularly in patients with lower total body area and smaller residual thyroid tissue without associated previous diffuse or multinodular goiter.
对于甲状腺癌患者，在近全甲状腺切除术后通过给予131I消融残留组织是一种惯例。最近的趋势是使用较低剂量的131I。本研究旨在评估1110 MBq（30 mCi）的131I对因乳头状、混合型或滤泡型甲状腺癌接受近全甲状腺切除术患者进行甲状腺消融的疗效。术后4个月，在停用左甲状腺素5 - 6周后，使用185 MBq（5 mCi）的131I进行全身扫描。然后通过甲状腺扫描的平面测量法测量残留甲状腺面积。患者在扫描后5天内接受消融治疗，并在6个月后进行一次或多次后续扫描。44例患者接受治疗以消融残留的功能性甲状腺组织。其中，12例（27%）消融成功。全甲状腺消融患者的全身面积（1.63±0.16对1.83±0.30，p<0.03）和残留甲状腺组织（1.4±1.4对2.0±1.2 cm2，p<0.05）较小，且这些患者中相关甲状腺肿的发生率有降低趋势（1/12对13/32，p<0.07）。17例全身面积小于1.9 m2和/或残留甲状腺组织小于2.1 cm2和/或既往无相关弥漫性或多结节性甲状腺肿的患者中有9例（53%）实现了全甲状腺消融，而27例不具备这些特征的患者中有3例（11%）治疗成功（p<0.005）。我们的数据表明，1110 MBq（30 mCi）的131I能够在近全甲状腺切除术后实现残留甲状腺组织的完全消融，特别是对于全身面积较小、残留甲状腺组织较小且既往无相关弥漫性或多结节性甲状腺肿的患者。
