Solomon B L, Wartofsky L, Burman K D
Department of Clinical Investigation, Walter Reed Army Medical Center, Washington, D.C. 20307-5001, USA.
J Clin Endocrinol Metab. 1996 Jan;81(1):333-9. doi: 10.1210/jcem.81.1.8550774.
Clinical members of the American Thyroid Association were surveyed in regard to their diagnostic assessment, treatment, and long term assessment of differentiated papillary thyroid carcinoma. For a 39-yr-old female with a 2-cm solitary nodule and no history of radiation (index patient), respondents were asked to provide their preferences for diagnostic evaluation, treatment assuming a papillary carcinoma was focal, and follow-up. Of 408 surveys mailed, 233 (57.1%) were analyzed. Diagnostic studies included thyroid scan (56%), fine needle aspiration (96%), total serum T4 (49%), and third generation TSH (56%). Treatment included surgery (99%), with 86% preferring near-total/total thyroidectomy. After surgery, 61% recommended 131I ablation; long term therapy using L-T4 alone was recommended by 97%, with most preferring suppression to a target TSH level of less than 0.01 microIU/mL (22%), 0.01-0.05 (38%), or 0.06-0.50 (32%). For variations from the index patient, respondents' treatment were not different for a history of radiation, age of either 16 or 60 yr, nodule size of 1.5 cm, male sex, the presence of less than 1-cm multiple foci in the contralateral lobe, or capsular invasion of the nodule. Treatment and follow-up did change if there was blood vessel invasion or distant metastasis. In summary, our survey indicated consensus on diagnostic assessment of the index patient by fine needle aspiration and management by surgery and 131I therapy. However, management varied widely for the ablative dose of 131I, the target TSH level after ablation, and the frequency and type of follow up.
美国甲状腺协会的临床成员接受了关于分化型甲状腺乳头状癌的诊断评估、治疗及长期评估方面的调查。对于一名39岁、有一个2厘米孤立结节且无放疗史的女性（索引患者），调查对象被要求给出他们对于诊断评估、假设为局灶性乳头状癌时的治疗以及随访的偏好。在邮寄的408份调查问卷中，233份（57.1%）被分析。诊断性检查包括甲状腺扫描（56%）、细针穿刺（96%）、血清总T4（49%）和第三代促甲状腺激素（56%）。治疗包括手术（99%），其中86%倾向于近全/全甲状腺切除术。手术后，61%建议进行131I消融；97%建议单独使用左甲状腺素进行长期治疗，大多数人倾向于将促甲状腺激素目标水平抑制到低于0.01微国际单位/毫升（22%）、0.01 - 0.05（38%）或0.06 - 0.50（32%）。对于与索引患者情况不同之处，调查对象对于放疗史、16岁或60岁年龄、1.5厘米的结节大小、男性、对侧叶存在小于1厘米的多个病灶或结节的包膜侵犯等情况的治疗并无差异。如果存在血管侵犯或远处转移，治疗及随访的确会有所改变。总之，我们的调查表明，对于索引患者通过细针穿刺进行诊断评估以及通过手术和131I治疗进行管理存在共识。然而，对于131I的消融剂量、消融后的促甲状腺激素目标水平以及随访的频率和类型，管理方式差异很大。
