1、Iodine-131 treatment for Differentiated Thyroid CarcinomaThyrid cancer Papillary thyroid carcinoma Follicular thyroid carcinoma Others:medullary thyroid cancer,anaplastic thyroid cancer.Etiology Prior exposure to radiation Dietary factors Genetic,endocrine and immunityClinical featureslSolitary thyr
2、oid nodule in anterior cervical triangle.lTo be discovered by accident or on routine physical examination.lPainless and moves druing deglutitionDiagnosislFine-needle aspiration of thyroid nodules lThyroid radioactive scan lUltrasound lCT or MRIlpathologyTreatmentSurgical therapyiodine-131 therapythy
3、roidhormoneTreatmentlSurgery is to clear up primary lesion,most normal thyroid tissue and regional metastases.l131I is to ablate the remnant thyroid tissue and metastasesl Lifelong thyroid hormone replacement is to prevent hypothyroidism and relapse PrinciplelThyroid gland accumulate 131I.lWell diff
4、erentiated thyroid cancers can take up 131I.lThe-radiation destroy those cancer lesions.Why do patients need 131I therapy?There are still some minimum cancers in the remnant thyroid tissue.If we ablate the remnant tissue,it is better to find metastases.Examine the level of thyroglobulin.Higher ablat
5、ion dose detect remnant or metastases better than diagnostic dose.Whole body scan after first 131I therapy Whole body scan after second 131I therapy Whole body scan with 10 mCi 131I Whole body scan with 150 mCi 131Iprocedure of 131I therapy131I ablate remnant thyroid tissue131I treat metastases131I
6、ablate remnant thyroid tissueIndication 131I ablation is used in patients who undergo thyorid surgery.131I uptake is above 1%Thyroid image show the remnant thyroid tissue.Therapeutic methods Patients should have low-iodine diet to double the 131I uptake.Stop thyroid hormone for 4-6 weeks.131I ablati
7、on is better to start in 4-6weeks later after surgery.To examine the thyroid function,X-ray,131I uptake,liver function,kidney function ect.Therapeutic methods Give the patient routine 100mCi 131I.To administer patient with prednisone 10mg three times a day after 131I therapy.drink a large quantitiy
8、of water.urinate in time.empty the bowels every day.have acidic food and vitam C.Women give a birth one years later after 131I therapy.men should have a baby 6 months later.therapeutic effect evaluation No thyroid remnant is detected in 131I scans.131I uptake is below 1%.131I treat metastasesIndicat
9、ion After 131I have successfully ablated remnat tissue,metastasis still uptake 131I.General state of health in patient is wellMethods Prepared Dose Lymph node metastases 100-150mCi Pulmonary metastases 150-200mCi Skeletal mestastases 200-250mCiSide reaction A few patinets show nausea,vomit and pain.
10、Pulmonary fibrosis in pulmonary metastasis.Very few patintes show bone marrow depression.Follow up Thyroglobulin131I scan Thyroid untorClinical case病例分析病例分析 Mr Wang，34 years old.Find a node on his left lobe.subtotal thyroidectomy comfirmed it is papillary cancer.Right lobe remain left in this picture Whole body scan
