甲状腺乳头状癌术后一般多久做碘131？
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<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"> <span style="color: black;"><a style="color: black;">甲状腺癌</a></span>术后<span style="color: black;">倘若</span><span style="color: black;">按照</span>病理<span style="color: black;">状况</span><span style="color: black;">必须</span>做碘-131治疗，<span style="color: black;">意见</span>在术后4-6周，<span style="color: black;">由于</span>做碘-131治疗之前<span style="color: black;">必要</span><span style="color: black;">处在</span>TSH高值的状态，<span style="color: black;">必须</span>大于30，在碘-131治疗前要停止<span style="color: black;"><a style="color: black;">左甲状腺素钠片</a></span>2-3周，使得TSH的值大于30，<span style="color: black;">这般</span>更有利于碘的摄取，显像更加<span style="color: black;">显著</span>。<span style="color: black;">同期</span>做碘-131治疗过早容易<span style="color: black;">引起</span><span style="color: black;"><a style="color: black;">甲状旁腺</a></span>的<span style="color: black;">损害</span>，<span style="color: black;">由于</span>术后可能会<span style="color: black;">显现</span>甲状旁腺功能一过性的减低、血供变差，<span style="color: black;">倘若</span>再次辐射治疗，可能会<span style="color: black;">引起</span><span style="color: black;"><a style="color: black;">永久性甲状旁腺<span style="color: black;">衰退</span></a></span>，<span style="color: black;">因此</span>不宜过早。<span style="color: black;">况且</span>做过碘-131之后<span style="color: black;">必须</span>4-6月复诊，第1次是清甲治疗，<span style="color: black;">倘若</span><span style="color: black;">发掘</span>有病灶，在4-6月以后进一步行<span style="color: black;"><a style="color: black;">清灶治疗</a></span>。</p>
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<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">结合2019版NCCN<span style="color: black;"><a style="color: black;">甲状腺癌指南</a></span>，总结<span style="color: black;">那些</span><span style="color: black;">状况</span>下的甲状腺乳头状癌术后<span style="color: black;">必须</span>做碘-131治疗：</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">1、满足以下所有<span style="color: black;">前提</span>者，不<span style="color: black;">举荐</span>做碘-131治疗：</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"> ①病理类型为典型的甲状腺乳头状癌</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"> ②原发肿瘤直径<span style="color: black;">少于</span>2厘米</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"> ③病灶未突破甲状腺包膜(包膜完整)</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"> ④单病灶或多病灶(所有病灶直径之和≤1cm)</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"> ⑤抗体TgAb阴性</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"> ⑥术后未刺激状态下Tg <1 ng/mL(甲状腺全切除术后6-12周的Tg值)</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">⑦术后颈部超声阴性(<span style="color: black;"><a style="color: black;">颈部淋巴结</a></span>未见<span style="color: black;">反常</span>)</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">2、存在以下任一条者，可<span style="color: black;">选取</span>性<span style="color: black;">举荐</span>做碘-131治疗：</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"> ①原发肿瘤最大直径2-4厘米</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"> ②高危病理学类型(低分化，高细胞型，柱状细胞型,<span style="color: black;"><a style="color: black;">图钉样细胞型</a></span>.)</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"> ③淋巴管受侵犯</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"> ④<span style="color: black;"><a style="color: black;">颈部淋巴结转移</a></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"> ⑤多发病灶，其中一个病灶直径>1cm</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">⑥术后未刺激状态下Tg <5-10ng/mL(甲状腺全切除术后6-12周的Tg值)</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"> ⑦镜下<span style="color: black;">发掘</span>肿瘤切除边缘阳性</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"> ⑧术后颈部<span style="color: black;"><a style="color: black;">超声阳性</a></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">然则</span>，以上<span style="color: black;">前提</span>中的以下<span style="color: black;">状况</span>不<span style="color: black;">必须</span>碘-131治疗：</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"> ①T1b/T2(1-4cm)cN0甲状腺乳头状癌</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"> ②N1a (少于3-5个转移淋巴结，淋巴结内癌灶< 5mm)甲状腺乳头状癌</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"> ③尤其是在<span style="color: black;">没</span>干扰<span style="color: black;"><a style="color: black;">抗Tg抗体</a></span>的<span style="color: black;">状况</span>下，术后Tg < 1ng /mL</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">当个别临床<span style="color: black;">原因</span>的<span style="color: black;"><a style="color: black;">组合预测</a></span>复发、远处转移或<span style="color: black;">疾患</span>特异性死亡的<span style="color: black;">明显</span><span style="color: black;">危害</span><span style="color: black;">增多</span>时(如原发肿瘤的<span style="color: black;">体积</span>、组织学类型、淋巴浸润程度、淋巴结转移<span style="color: black;">状况</span>、术后Tg、发病年龄)，<span style="color: black;">举荐</span><span style="color: black;">运用</span>碘-131。</p>
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<h2 style="color: black; text-align: left; margin-bottom: 10px;"> 碘-131治疗前准备</h2>
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<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">1、TSH准备</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"> 碘-131治疗前需<span style="color: black;">上升</span><span style="color: black;"><a style="color: black;">血清TSH</a></span>水平至30 μU/mL以上。确定清甲治疗的<span style="color: black;">病人</span>可<span style="color: black;">选取</span>停服<span style="color: black;"><a style="color: black;">L-T4</a></span>或给予外源性重组人TSH(recombinant human TSH，rhTSH)来<span style="color: black;">上升</span>TSH。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">2、低碘准备</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"> 碘-131治疗的疗效取决于进入残留甲状腺组织和DTC内的碘-131活性。为了减少<span style="color: black;">身体</span><span style="color: black;"><a style="color: black;">稳定碘</a></span>对碘-131的竞争性<span style="color: black;">控制</span><span style="color: black;">功效</span>，<span style="color: black;">加强</span>碘-131治疗效果，在碘-131治疗前应保持低碘<span style="color: black;">膳食</span>(碘摄入量<50 μg/d);治疗前1～2个月内避免<span style="color: black;"><a style="color: black;">行碘<span style="color: black;">加强</span>剂</a></span>的应用，如<span style="color: black;">加强</span>CT<span style="color: black;">检测</span>、冠脉造影;避免<span style="color: black;">吃下</span><span style="color: black;"><a style="color: black;">胺碘酮</a></span>等影响碘摄取或代谢的<span style="color: black;">药品</span>。因<span style="color: black;">吃下</span><span style="color: black;">食品</span>及<span style="color: black;">药品</span>差异，个人体质及代谢等不同，<span style="color: black;">详细</span>还应结合<span style="color: black;">病人</span>的尿碘、<span style="color: black;"><a style="color: black;">尿碘肌酐</a></span>比值或血碘检测结果来<span style="color: black;">选取</span>碘-131治疗<span style="color: black;">机会</span>。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">3、育龄女性<span style="color: black;">关联</span><span style="color: black;">重视</span>事项</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">因碘-131可经过胎盘及乳汁对胎儿和婴幼儿产生辐射，<span style="color: black;">因此呢</span>实施碘-131治疗前，对育龄女性需除外其妊娠状态，对妊娠及哺乳女性禁行碘-131治疗。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">4、<span style="color: black;">病人</span><span style="color: black;">通常</span>状态<span style="color: black;">评定</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"> 行碘-131治疗前应常规行血常规、肝肾功能等<span style="color: black;">检测</span>，<span style="color: black;">评定</span><span style="color: black;">病人</span>的<span style="color: black;">通常</span>状态。<span style="color: black;">针对</span>伴有<span style="color: black;">基本</span><span style="color: black;">疾患</span>等可能<span style="color: black;">没</span>法耐受撤甲状腺激素<span style="color: black;">导致</span><span style="color: black;"><a style="color: black;">甲减</a></span>，以及<span style="color: black;">没</span>法耐受碘-131治疗的<span style="color: black;">病人</span>，<span style="color: black;">意见</span>多学科会诊，<span style="color: black;">掌控</span>基础<span style="color: black;">疾患</span>使其稳定后再行<span style="color: black;"><a style="color: black;">碘-131治疗</a></span>;<span style="color: black;">针对</span><span style="color: black;">没</span>法遵从放射防护<span style="color: black;">需求</span>者，应在<span style="color: black;">通知</span><span style="color: black;">病人</span>及其家属<span style="color: black;">关联</span>利<span style="color: black;">坏处</span>后，<span style="color: black;">谨慎</span><span style="color: black;">思虑</span>碘-131治疗。</p>
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