大型多结节性甲状腺肿放射性碘治疗的剂量测定与风险评估

Dosimetry and risk estimates of radioiodine therapy for large, multinodular goiters.

作者信息

Huysmans D A, Buijs W C, van de Ven M T, van den Broek W J, Kloppenborg P W, Hermus A R, Corstens F H

机构信息

Department of Nuclear Medicine, University Hospital Nijmegen St. Radboud, The Netherlands.

出版信息

J Nucl Med. 1996 Dec;37(12):2072-9.

PMID:8970537

Abstract

UNLABELLED

In patients with a large, multinodular goiter (> 100 g), radiation absorbed doses in the thyroid, surrounding tissues and remainder of the body were estimated after therapeutic administration of 131I(3.7 MBq or 100 microCi/g of thyroid tissue retained at 24 hr).

METHODS

Thermoluminescent dosimeter (TLD) measurements were performed on 23 patients (12 euthyroid and 1I hyperthyroid; thyroid weight 222 +/- 72 g; 2.1 +/- 0.9 GBq 131I) on the skin over the thyroid, over the submandibular gland and over the parotid gland. Thyroid radioactivity measurements were done daily in 6 euthyroid and 6 hyperthyroid patients (thyroid weight 204 +/- 69 g; 1.9 +/- 0.9 GBq 131I). An iodine biokinetic model and the MIRD methodology were used to estimate absorbed doses in organs. Cancer risks were calculated using ICRP Publication 60.

RESULTS

Cumulated absorbed doses on the skin (TLD measurements) were 4.2 +/- 1.4 Gy (thyroid), 1.2 +/- 0.6 Gy (submandibular) and 0.4 +/- 0.2 Gy (parotid). All these values were significantly correlated with the amount of radioiodine retained in the thyroid at 24 hr (euthyroid versus hyperthyroid not significant). Absorbed doses in the thyroid of 94 +/- 25 Gy for euthyroid and 93 +/- 17 Gy for hyperthyroid patients were calculated (thyroid radioactivity measurements). Extrathyroidal absorbed doses (means of 12 patients) were 0.88 Gy in the urinary bladder, 0.57 Gy in the small intestine, 0.38 Gy in the stomach, and ranged from 0.05 to 0.30 Gy in other organs (euthyroid versus hyperthyroid not significant). A 1.6% life-time risk of development of cancer outside the thyroid gland was calculated. When applied to people of 65 yr and older the estimated risk is approximately 0.5%.

CONCLUSION

These data may help in choosing the treatment regimen for individual patients with a large, multinodular goiter, who have to be treated for hyperthyroidism or compressive problems. In younger patients, surgery may be preferred. However, for elderly patients and patients with cardiopulmonary disease, the advantages of noninvasive radioiodine treatment will outweight the life-time risk of this mode of therapy.

摘要

未标记

对于患有大的多结节性甲状腺肿（>100克）的患者，在给予131I治疗性给药（24小时时甲状腺组织保留3.7MBq或100微居里/克）后，估计甲状腺、周围组织和身体其余部分的辐射吸收剂量。

方法

对23例患者（12例甲状腺功能正常和11例甲状腺功能亢进；甲状腺重量222±72克；2.1±0.9GBq 131I）在甲状腺上方皮肤、下颌下腺上方和腮腺上方进行热释光剂量计（TLD）测量。对6例甲状腺功能正常和6例甲状腺功能亢进患者（甲状腺重量204±69克；1.9±0.9GBq 131I）每日进行甲状腺放射性测量。使用碘生物动力学模型和MIRD方法估计器官中的吸收剂量。使用国际放射防护委员会第60号出版物计算癌症风险。

结果

皮肤（TLD测量）的累积吸收剂量为4.2±1.4Gy（甲状腺）、1.2±0.6Gy（下颌下腺）和0.4±0.2Gy（腮腺）。所有这些值均与24小时时甲状腺中保留的放射性碘量显著相关（甲状腺功能正常与甲状腺功能亢进之间无显著差异）。计算出甲状腺功能正常患者甲状腺的吸收剂量为94±25Gy，甲状腺功能亢进患者为93±17Gy（甲状腺放射性测量）。甲状腺外吸收剂量（12例患者的平均值）在膀胱中为0.88Gy，在小肠中为0.57Gy，在胃中为0.38Gy，在其他器官中为0.05至0.30Gy（甲状腺功能正常与甲状腺功能亢进之间无显著差异）。计算出甲状腺外发生癌症的终生风险为1.6%。应用于65岁及以上人群时，估计风险约为0.5%。