医学精品课件：16.2放射性核素治疗甲亢.ppt

1、LOGORadionuclide TherapyGuan LiliDepartment of Nuclear Medicine,Chongqing Medical University The radionuclide is administered into the body and it concentrates in a certain type of supernumerary or abanormal cells.The ionising effect of radiation can destroy those cells.What is the Radionuclide Ther

2、apy?1942Graham Bell made use of radioactive sources on tumors.This marked the beginning of curietherapy.John Lawrence injuected Phosphorus 32 to a patient as a treatment of leukaemia.Samuel Seidlin demonstrated that it was possible,following treatment with Iodine 131,to destroy thyroid cancerHistory

3、 19001936 1942Saul Hertz used Iodine 131 to treat patients affected with hyperthyroidism.1946Radioiodine therapy for thyroid diseases Thyroidv The thyroid,the largest endocrine gland in body,weighs about 20-25g.v Thyroid gland secrete thyroid hormone,which enhance the growth and development of human

4、 body and energy metabloism.The iodine,in the form of iodide salt,spontaneously accumulates in the thyroid tissues.ThyroidradioiodineRadioiodineThemeGallery is a Design Digital Content&Contents mall developed by Guild Design Inc.What kinds of disesae can iodine-131 manage?Nontoxic Goiter Autonomous

5、Functional Thyroid Nodules Graves dieaseDifferentiated Thyroid Carcinoma Radiodine-131 Treatment for Graves disease(GD)Graves diseasevGraves disease is the common cause of hyperthyroidism,representing 80%85%of all hyperthyroidism.vGraves disease is most likely an autoimmune disorder.vIt affects wome

6、n about five times more frequntly than men.Clinlic features High metabolism symptoms heat intolerance,weight loss,good appetite.Diffuse goiter Palpation most frequently reveals diffuse and symmetric thyroid enlargement.Autoimmune processes mediate the enlargement of the thyroid gland.Graves ophthalm

7、opathy infiltrative ophthalmopathy,tearing,a feeling of sand in the eyes,photophobia,diplopia,and decreased visual acuity.Diffuse GoiterGraves ophthalmopathyantithyroid drugs Radioiodine surgery Radioiodine Antithyroid drugs(ATDS)AdvantagevLong-term ATD therapy may lead to remission in some patients

8、.vThe incidence of hypothyroidism with ATDs is lower than radioiodine.DisadvantagevThe duration therapy usually needs 6 months to 2 years.Some patients spend more time than 2 years with ATDs.vThere are some avderse reaction to ATDs.a few patients even appear serious reaction.vThe relapse rate with A

9、TD are high.Surgeryv When a patient with very large goiter,thyroidectomy is infrequently recommended.v Complications of surgery:hypoparathyroidism and injury to the recurrent laryngeal nerve.Iodine-131AdvantagevTreatment with iodine-131 is very safe.v80%patients cure with Iodine-131 at once.vMost pa

10、tients have no reacion after Iodine-131 treatment.Disadvantagev 20%patients may have permanent hypothyroidism.vThyroid gland with hyperthyroidism accumulates more iodine-131,which stay for a long time in the gland.vThe-radiation given by iodine-131 is effective in irradiating the local region of tis

11、sue.vSince-radiation is able to travel only millimeters in tissue,it is no harm to other tissue or organs.PricinpleIndication vAlduts with moderate hyperthyroidism and thyroid enlargement.vPatients with a prior allergic or toxic reaction to the antithyroid drugs.vFrequent medication intake cannot be

12、 guaranteed.v Hyperthyoidism with cardiac complications，hypolekocytosis，diabetes.vChildren or adolescent after a course of antithyroid medication has failed or unable to surgery.Contraindication Therapy with iodine-131 is contraindicated during pregnancy and in woman who are breast-feeding.How to tr

13、eat with iodine-131?Pretherapy vAntithyroid drugs should be stopped for 3-4days.v Food contain iodine should not be eaten.vThen patients should detect iodine-131 uptake and the effective half life.Measure of thyroid homone values.DosevTo delivering 80Ci-120 Ci iodine-131 per gram of thyroid tissue.t

14、he 80-120Ci is then multiplied by the estimated weight of the gland and corrected for iodine-131 uptake.Dose=vTo give the patients with identical iodine-131 dose，usually 3-10mCi.Gland size desired doseRAIU at 24 hoursAdministrationvIodine-131 is delivered to the boby usually by oral at once on an em

15、pty stomach.Notice after iodine-131 therapy vEating is prohibited until 2 hour later after radioactive therapy.vPatient should take an adequate rest and avoid to be tire,excitation and infection.vFood and drug containing iodine shouldnt be taken for a month.vDont press thyroid gland.Notice after rad

16、ioactive therapyv Dont get in touch with infant in a week.vWoman who have iodine-131 therapy shoudnt have a baby until 6 months later.And man should birth control for 6 months.vDoctor should inform patients about therapeutic reaction and following-up.Therapy reactionvMost patients no reaction.vA few

17、 paitients:lack of power,lightheadedness,bad appetite,nausea and vomitting,itch of skin,swelling of thyroid.vA few patitients:worsen of Graves ophthalmopathy,thyroid storm.Follow-upvPatient usually are informed to follow-up in 2 or 3 month after therapy.vDoctor should measure thyroid hormmon value,n

18、otice the syptom and examine the physical sign.ComplicationHypothyroidism is a common sequela of iodine therapy.Continuing carevHypothyroidism generally ensues following treatment within the first 6 to 12 months following therapy,but may occur at any time.Therefore,at least annual follow-up is necessary for those individuals who continue to be euthyroid.Clinical Cases 131 131I Ihalf a year later131Ihalf a year laterLOGOAdd your company slogan