Japanese
Title131I全身シンチグラフィによる甲状腺分化癌転移巣の早期診断と131I治療
Subtitle原著
Authors池窪勝治*, 日野恵*, 伊藤秀臣*, 山口晴司*, 才木康彦*, 宇井一世*, 富永悦二*, 中西昌子*, 川井順一*, 黄俊清**, 石原隆**, 服部尚樹**, 倉八博之**, 大村正樹***, 森徹****
Authors(kana)
Organization*神戸市立中央市民病院核医学科, **内科, ***耳鼻咽喉科, ****京都大学第二内科
Journal核医学
Volume28
Number3
Page247-259
Year/Month1991/3
Article原著
Publisher日本核医学会
Abstract「要旨」甲状腺分化癌の転移巣の早期診断と治療を目的として, 過去9年間に131I全身スキャン (131I TBS) を施行した132例につき検討した. 132例中24例 (18%) は131I TBSによって始めて転移が認められた. 131I治療をうけた49例の転移例中27例 (55%) は術後1年以内に転移が検出され, 全例最初の甲状腺手術が全摘であった. 残りの22例 (45%) は最初の手術時 (片葉切除14例, 全摘8例) には転移に気付かれず1年〜31年 (平均8.4年) 後になって転移が認められた. 全摘から131I TBSまでの最適の期間を決定するため20例で全摘後の血中甲状腺ホルモン, TSH, Tg濃度を経時的に観察した. その結果全摘に引続き131I TBSを行うまでの期間は3〜4週間が適切であると判断された. 転移例52例の131I TBS施行時のスキャンと血中Tg濃度の成績の比較では52例中43例 (83%) がスキャン陽性, 46例 (88%) がTg高値 (> 10ng/ml) であった. スキャン陰性でTg高値が9例, スキャン陽性でTg低値が6例に認められ, 転移巣の検出には131I TBSと血中Tgの同時検索が必要であると考えられた. 治療効果は治療効果の判定できた65例中治癒5例を含む49例 (75%) で有効性を認めた. 悪化2例と死亡6例は全例56歳以上の高齢であった. 治療量の131I TBSは診断量の131I TBSに比べて病巣の範囲の描出にすぐれた.
Practice臨床医学：一般
KeywordsDifferentiated thyroid cancer, Total thyroidectomy, 131I Total body scan, 131I Therapy, Serum thyroglobulin.
English
TitleThe Early Detection of Metastatic Differentiated Thyroid Cancer Using 131I Total Body Scan and Treatment with 131I
SubtitleOriginal Articles
AuthorsKatsuji IKEKUBO*, Megumu HINO*, Hidetomi ITO*, Haruji YAMAGUCHI*, Yasuhiko SAIKI*, Kazuyo UI*, Etsuji TOMINAGA*, Masako NAKANISHI*, Junichi KAWAI*, Toshikiyo KOH**, Takashi ISHIHARA**, Naoki HATTORI**, Hiroyuki KURAHACHI**, Masaki OOMURA***, Toru MORI****
Authors(kana)
Organization*Department of Nuclear Medicine, **Department of Internal Medicine, ***Department of Otorhinolaryngology, Kobe City General Hospital, ****Second Division of Internal Medicine, Kyoto University School of Medicine
JournalThe Japanese Journal of nuclear medicine
Volume28
Number3
Page247-259
Year/Month1991/3
ArticleOriginal article
PublisherTHE JAPANESE SOCIETY OF NUCLEAR MEDICINE
Abstract[Summary] With the purpose of achieving early detection and performing 131I therapy for metastatic lesions of differentiated thyroid cancer, we studied the clinical findings in 132 patients who underwent 131I total body scanning (131I TBS) between 1981 and 1990. Metastatic lesions were detected only by 131I TBS in 24 (18%) of the 132 patients. Of the 49 patients treated with 131I for metastases, 27 (55%) underwent total thyroidectomy and then had their metastatic lesions treated by 131I less than one year later. In the remaining 22 patients (45%), the metastatic lesions were treated with 131I from 1 to 31 years (mean : 8.4 years) after the initial thyroidectomy. We determined the optimal timing of 131I TBS following radical thyroidectomy to be 3 - 4 weeks by sequential measurement of the serum thyroid hormones, TSH, and Tg, and determination of the 123I uptake in residual or metastatic cancer of the neck after thyroidectomy. 131I TBS with simultaneous serum Tg determition were performed in 52 patients with metastases. Scans were positive in 43 of the 52 (83%) and the serum Tg level was greater than 10 ng/ml in 46 of the 52 (88%). Serum Tg was elevated in 9 patients with negative scans, while low Tg levels were found in 6 patients with positive scans. 131I therapy was effective in 49 of the 65 treated patients (75%), including 5 cures. Two patients worsened and 6 died. These 8 patients were all older than 56 years of age. Post-therapeutic 131I TBS demonstrated unsuspected metastatic lesions in 7 patients and had a higher detection rate for metastatic lesions than diagnostic 131I TBS. We conclude that 131I TBS with simultaneous Tg determination should be performed to detect metastatic lesions in all patients following positively total thyroidectomy for differentiated thyroid cancer, and that 131I treatment should be given when positive 131I uptake is detected in metastatic or residual cancer.
PracticeClinical medicine
KeywordsDifferentiated thyroid cancer, Total thyroidectomy, 131I Total body scan, 131I Therapy, Serum thyroglobulin.

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