关键词: 甲状腺微小癌, 乳头状癌, 放射性碘-131治疗

Abstract:

Radioactive iodine-131 therapy of papillary thyroid microcarcinoma        LIN Yan-song，YANG Xue. Department of Nuclear Medicine，Peking Union Medical College Hospital，Beijing 100730, China
Corresponding author：LIN Yan-song，E-mail：linys@pumch.cn
Abstract    Radioactive iodine-131（131I） therapy is an effective modality of adjuvant therapy after total thyroidectomy or near-total thyroidectomy for thyroid microcarcinoma（TMC）. Most lesions are confined to the thyroid without other risk factors. However，a minority of lesions present aggressive characteristics such as extrathyroidal extension，cervical lymph node involvement and distant metastasis. Therefore，the decision-making recommendations for papillary thyroid carcinoma（PTC） with tumor diameter larger than 1 cm are not appropriate to be applied directly to TMC. In addition，because of the lack of large-scale，prospective，multicenter clinical research evidence，131I therapy even the extent of surgery for TMC is still controversial. TMC especially PTMC patients with coexistent or multiple invasive features (such as multifocility, pathological subtype such as tall cell or solid subtype and moleculer characteristics such as BRAF mutation) should be particularly paid attention during the risk reassessment before 131I therapy. Both pathological characteristics and postoperative dynamic risk stratification should be considered during risk assessment before 131I therapy. Throglobulin (Tg) especially preablative stimulated Tg is a pivotal marker for predicting disease-free status, disease persistence and distant metastasis. It would never be too cautious to emphasize that 131I therapy decision-making should be made in terms of different risk through considerable assessment.

Key words: thyroid microcarcinoma, papillary carcinoma, radioactive iodine-131 treatment