上海交通大学学报（医学版）

›› 2012, Vol. 32 ›› Issue (1): 82-.doi: 10.3969/j.issn.1674-8115.2012.01.016

• 论著（临床研究） • 上一篇    下一篇

分化型甲状腺癌合并甲状腺功能亢进症患者的临床特征及131I清除甲状腺残余组织的疗效

盛矢薇|陆汉魁|陈立波|罗全勇   

  1. 上海交通大学附属第六人民医院核医学科, 上海 200233
  • 出版日期:2012-01-28 发布日期:2012-01-29
  • 通讯作者: 陆汉魁, 电子信箱: luhankui@sina.com。
  • 作者简介:盛矢薇（1981—）, 女, 住院医师, 学士；电子信箱: sswfrandy1981@hotmail.com。

Clinical features and efficacy of 131I remnant ablation of differentiated thyroid carcinoma complicated with hyperthyroidism

SHENG Shi-wei, LU Han-kui, CHEN Li-bo, LUO Quan-yong   

  1. Department of Nuclear Medicine, the Sixth People's Hospital, Shanghai Jiaotong University, Shanghai 200233, China
  • Online:2012-01-28 Published:2012-01-29

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摘要：

目的 探讨分化型甲状腺癌（DTC）合并甲状腺功能亢进症（甲亢）患者的临床特征及131I清除甲状腺残余组织（清甲）的疗效。方法 回顾性分析2000年1月—2009年12月收治的1 233例DTC患者的临床资料，其中13例患者既往有甲亢病史。入院前停用甲状腺素片，同时禁碘饮食3~6周，服用131I治疗前检测血清甲状腺球蛋白、甲状腺球蛋白抗体、甲状腺激素（TT3、TT4、FT3、FT4）、促甲状腺激素（TSH）、血常规和肝、肾功能，选择性行颈部超声等影像学检查评估病情。所有患者给予口服131I后4~6个月，随访清甲治疗的效果。结果 DTC合并甲亢患者颈部超声对甲状腺癌的阳性检出率为61.54%（8/13），甲状腺显像阳性检出率为33.33%（2/6），细针穿刺细胞学检查阳性检出率为75.00%（3/4）。DTC合并甲亢患者清甲所需的131I总剂量明显低于单纯DTC患者，差异具有统计学意义（P<0.05）。131I治疗后4~6个月随访，13例DTC合并甲亢患者中，首次131I治疗即清甲成功的患者有11例，占84.62%，明显高于同期单纯DTC患者的一次131I清甲成功率55.90%。结论 颈部超声、甲状腺显像和细针穿刺细胞学检查仍是DTC合并甲亢患者的重要检查手段，DTC合并甲亢患者131I清甲疗效优于单纯DTC患者。

关键词: 分化型甲状腺癌, 甲状腺功能亢进症, 131I

Abstract:

Objective To investigate the clinical features and efficacy of 131I remnant ablation of differentiated thyroid carcinoma complicated with hyperthyroidism. Methods The clinical data of 1 233 patients with DTC hospitalized between January 2000 and December 2009 were retrospectively analysed, among whom 13 had history of hyperthyroidism. Thyroxine tablets administration withdrew before admission, and iodine-free diet was carried out for 3 to 6 weeks. Before 131I treatment, serum thyroglobulin, thyroglobulin antibodies, thyroid hormones (TT3, TT4, FT3, FT4), thyroid stimulating hormone （TSH）, blood routine, liver and renal function were examined, and the disease condition was evaluated by neck ultrasound. Four to 6 months after 131I treatment, all patients were followed up for the treatment efficacy. Results The positive rate of thyroid ultrasonography for DTC complicated with hyperthyroidism was 61.54% （8/13）, and those of thyroid scintigraphy and fine needle aspiration biopsy were 33.33% （2/6）and 75.00% (3/4) respectively. The total dose of 131I used for DTC complicated with hyperthyroidism was significantly lower than that for DTC （P<0.05）. Four to six months after 131I remnant ablation, 11of the 13 patients (84.26%) had successful ablation of residual thyroid tissues after first administration of 131I, which was significantly higher than that of patients with single DTC (55.90%). Conclusion Thyroid ultrasonography, thyroid scintigraphy and fine needle aspiration biopsy remain important means in examining patients with DTC complicated with hyperthyroidism. 131I treatment for ablation of residual thyroid tissues in patients with DTC complicated with hyperthyroidism may yield better efficacy than in patients with single DTC.

Key words: thyroid carcinoma, primary hyperthyroidism, 131I