Résumé
Objective: To explore the correlation between the treatment of precurative stimulated thyroglobulin (sTg) level and 131 iodine treatment in patients with high-risk differentiated thyroid carcinoma (DTC). Methods: After 131 iodine therapy in The First Affiliated Hospital of Xian Jiaotong University from March to June 2016, the patients with high-risk DTC were followed up. We compared the clinical characteristics and pre-treatment sTg level, ROC curve and the evaluation of the best diagnostic boundary value point sTg predictive value of iodine ER after treatment in satisfaction (excellent response, ER), (acceptable response, AR), and (incomplete response, IR) groups by means of chi square test and One-way ANOVA. Results: There were 91 high-risk DTC patients treated with iodine-131, including 23 males and 68 females, with an average age of 45.62±11.84 years, with an average of 131 iodine doses of (121.4±17.3)mCi. We analyzed retrospectively the follow-up results of 78 patients (46 cases of ER, 14 cases of AR, and 18 cases of IR). The three groups did not differ significantly in age, gender, or invasion outside the thyroid gland (P=0.300, 0.299, 0.274). however, they differed significantly in primary lesion diameter, neck lymph node metastasis, 131 iodine treatment dose, and postoperative sTg level (P=0.018,0.003, 0.000, 0.000). The levels of sTg and 131 iodine treatment dose were significantly higher in IR group than in non-IR groups (P=0.008), but they had no significant difference between AR and IR groups (P=0.786). In IR group the sTg boundary value point was 9.69 ng/mL (sensitivity 66.7%, specificity 86.9%), ROC curve was 0.897, and 95% CI was 0.826-0.968. Conclusion: The level of sTg in patients with moderate- and high-risk DTC is predictive of clinical outcome after 131 iodine treatment. The level of sTg after operation is higher than 9.69 ng/mL, which can be used as the cut-off point to indicate the poor curative effect.
Résumé
Objective To explore the optimal time for starting to drink plenty of water after 131I treatment in differentiated thyroid carcinoma(DTC) patients.Methods Totally 83 cases of DTC patients were randomly divided into three groups,and started to drink plenty of water at 12 h(group A),24 h(group B),and 36 h(group C) after treatment with 131I therapy.We measured and compared equivalent dose rate using the Inspector Alert gamma ray monitor at 1 meter in front of the patient's abdomen and neck at 6 h,12 h,24 h,36 h,48 h,72 h after taking 131I.We compared the discharge rate at different time and evaluated the curative effect.Results Equivalent dose rate of the abdomen at 24 h and 36 h after treatment and the discharge rate at 36 h and 48 h after treatment among three groups showed significant differences(P＜0.05).There were no statistically significant differences in the curative effect(P＞0.05).Conclusion Starting to drink plenty of water at 12 h after taking 131I can accelerate the decreasing of equivalent dose rate with no influence on the curative effect and improve the discharge rate at early.
Résumé
Com o objetivo de avaliar os custos e a efetividade das 2 formas de tratamento mais utilizadas em nosso meio para a Doença de Graves, iodo radioativo e tratamento clínico prolongado, analisamos pacientes submetidos a essas terapias na região de Maringá, PR. Foram estudados 23 pacientes, 7 homens e 16 mulheres, com idade média de 35,4 anos, submetidos ao tratamento clínico, e 34 pacientes, 5 homens e 29 mulheres, com idade média de 39,4 anos, submetidos à dose terapêutica com iodeto de sódio (iodo-131). Após 2 anos de tratamento clínico com tiamazol (Tapazol®), 21 pacientes atingiram o eutireoidismo e dois permaneceram hipertireóideos. No grupo da dose terapêutica com iodeto de sódio (iodo-131), 21 pacientes evoluíram para o hipotireoidismo, enquanto que 13 atingiram o eutireoidismo. Para o cálculo do custo de cada modalidade de tratamento, analisamos o número de consultas necessárias durante o seguimento, exames complementares solicitados e medicações utilizadas, como tiamazol e/ou tiroxina. O grupo submetido ao tratamento clínico necessitou de maior número de consultas e exames, sendo que o custo médio foi de R$ 1.345,81 neste período de dois anos, enquanto que no grupo com iodeto de sódio (iodo-131) o valor médio foi de R$ 622,94. Assim, os custos da dose terapêutica com iodeto de sódio (iodo-131) foram 53,7 por cento menores do que o tratamento clínico com drogas antitireoidianas. Este trabalho demonstra que o tratamento com dose terapêutica com iodeto de sódio (iodo-131) apresenta um menor custo, sendo bastante efetivo no controle do hipertireoidismo na doença de Graves.
In this study, we set out to evaluate the costs and effectiveness of the 2 most used therapies in our region, ATD or RAI. 23 patients, 6 men and 16 women, with a mean age of 35.4 years, treated with ATD, and 35 patients, 5 men and 30 women, mean age of 39.4 years, treated with RAI, were studied. After 2 years receiving ATD, 21 patients achieved euthyroidism and 2 remained hyperthyroid. In the RAI group, 21 patients presented hypothyroidism and 13 became euthyroid. To calculate the costs of each therapy, we analyzed the number of visits during this period, the laboratory data and the drugs needed, such as tiamazol and/or thyroxine. The group treated only with ATD needed a higher number of visits and laboratory measurements, with the mean total cost of R$ 1,345.81, while the RAI group spent a mean amount of R$ 622.94. Therefore, the costs of the RAI treatment were 53.5 percent lower than clinical therapy with ATD. The present study demonstrates that RAI treatment has a lower cost than ATD, being very effective in controlling the hyperthyroidism of Graves disease.