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有研究认为,术后第1次随访时对甲状腺球蛋白水平升高的低恶度甲状腺癌患者需进行重复131I治疗。在接受甲状腺全切除术和131I治疗的407例甲状腺癌患者中,根据12例Ⅰ期甲状腺癌患者血液中的甲状腺球蛋白的水平给予1～4个疗程3.7GBq的131I治疗。研究结果显示,3名患者的131I扫描为阴性,在治疗过程中没有任何不良反映;2名患者甲状腺床仅有轻微131I摄取,但超声检查阴性;4名患者仅在纵膈区域有131I摄取,但是随后补充的纵膈扫描没有发现异常情况,这一现象被解释为胸腺的良性131I摄取;最后3名患者既有纵膈胸腺摄取,也有轻微的甲状腺床摄取。1名患者的甲状腺球蛋白持续增长并且接受了颈部无功能淋巴结切除术。其他患者的甲状腺球蛋白水平下降。研究认为,在给一组年轻的低恶度甲状腺癌术后甲状腺球蛋白水平增高的患者131I治疗中没有发现远期损害。但当盲目的131I治疗显示甲状腺组织不摄取或仅胸腺摄取131I时,患者不应再被给予131I治疗。研究者讨论了一个假设:活性增强的胸腺也许是良性甲状腺球蛋白分泌的一个来源。
Some studies suggest that patients with low-grade thyroid cancer with elevated thyroglobulin need repeat 131I treatment at the first postoperative follow-up. Of the 407 thyroid cancer patients who underwent total thyroidectomy and 131I, they received 3.7 GBq of 131I for 1 to 4 courses based on the thyroid globulin level in 12 patients with stage I thyroid cancer. The results of the study showed that 131I scans were negative in 3 patients and did not show any adverse reactions during the course of treatment; only 131I uptake in the two thyroid glands was found in the 2 patients, but the ultrasound was negative; 4 patients had 131I uptake only in the mediastinum area, However, no additional abnormality was observed with the subsequent mediastinum scan. This phenomenon was interpreted as a benign 131I uptake in the thymus; the last three patients had both mediastinal thymus and mild thyroid uptake. One patient’s thyroglobulin continued to grow and underwent cervical non-functional lymph node dissection. Thyroglobulin levels decreased in other patients. The study concluded that no long-term lesions were found in 131I treatment of patients with elevated thyroglobulin levels after a series of younger patients with low-grade thyroid cancer. However, when blind 131I therapy shows no thyroid tissue uptake or 131I thymectomy alone, the patient should no longer be treated with 131I. The researchers discussed the hypothesis that an activated thymus may be a source of benign thyroglobulin secretion.