Kasagi K, Miyamoto S, Endo K, Sasayama S, Takeuchi R, Hidaka A, Iida Y, Misaki T, Hatabu H, Konishi J
Department of Nuclear Medicine, Kyoto University, Japan.
Cancer. 1993 Sep 15;72(6):1983-90. doi: 10.1002/1097-0142(19930915)72:6<1983::aid-cncr2820720632>3.0.co;2-k.
In an attempt to determine possible factors affecting the efficacy of iodine-131 (I-131) treatment for metastatic thyroid carcinoma, the authors focused their efforts on thyroid functions after total thyroidectomy.
Between 1980 and 1991, 47 patients with lung metastases of differentiated thyroid carcinoma were treated with I-131. Relationships of the images on post-therapy scans with various clinical features were studied.
Among them, 28 (59.6%) showed I-131 uptake in the metastases on post-therapy scans. Younger patients had lesions that concentrated more radioactive iodine than did those of older patients. The amount of I-131 concentrated in the metastatic lesions correlated with serum triiodothyronine (T3), thyroxine (T4), and thyroglobulin levels and inversely with serum thyroid-stimulating hormone (TSH) levels determined at the time of therapy. Serum T3 and T4 levels were significantly higher in 28 patients with positive scans than in 19 patients with negative scans. Most patients who had metastases with markedly increased radioactivity were euthyroid or mildly hypothyroid, suggesting that thyroid hormones produced by tumor masses compensated for severe hypothyroidism after total thyroidectomy, and showed favorable responses to the treatment. In three patients successfully treated, decreases in serum thyroglobulin levels and the size of metastatic lesions were accompanied by the development of severe hypothyroidism.
The presence of a large amount of metastatic functioning thyroid tissues responsive to I-131 treatment can be suspected in patients with less severe hypothyroidism after total thyroidectomy.
为了确定可能影响碘-131（I-131）治疗转移性甲状腺癌疗效的因素，作者将研究重点放在全甲状腺切除术后的甲状腺功能上。
1980年至1991年间，47例分化型甲状腺癌肺转移患者接受了I-131治疗。研究了治疗后扫描图像与各种临床特征之间的关系。
其中，28例（59.6%）在治疗后扫描中显示转移灶有I-131摄取。年轻患者的病灶比老年患者的病灶摄取更多的放射性碘。转移灶中I-131的摄取量与治疗时测定的血清三碘甲状腺原氨酸（T3）、甲状腺素（T4）和甲状腺球蛋白水平相关，与血清促甲状腺激素（TSH）水平呈负相关。扫描阳性的28例患者血清T3和T4水平显著高于扫描阴性的19例患者。大多数转移灶放射性明显增加的患者甲状腺功能正常或轻度甲状腺功能减退，这表明肿瘤组织产生的甲状腺激素补偿了全甲状腺切除术后的严重甲状腺功能减退，并且对治疗反应良好。在3例成功治疗的患者中，血清甲状腺球蛋白水平和转移灶大小的减小伴随着严重甲状腺功能减退的出现。
全甲状腺切除术后甲状腺功能减退较轻的患者，可能存在大量对I-131治疗有反应的转移性功能性甲状腺组织。
