| Thyroid cancer is the most common endocrine system tumor, accounting for 1.3% of all malignant tumors,0.4% of cancer mortality,30% of primary epithelial thyroid cancer, and the ratio of male to female is 2:3. Thyroid cancer occurs at any age, but more commonly in 40-50 years old.As medical technology advancing, the methods to treat thyroid cancer are gradually improving. At present, the most popular treatment program is surgery adding 131I treatment and thyroid hormone suppression therapy. Surgery is the first and foremost treatment what we must apply. We cann't apply 131I treatment until resection of primary cancer is carried out.131I, as a follow-up treatment of thyroid cancer, is divided into two steps:the first step is for thyroid remnant; the second is for metastasis.Radioactive iodine (131I) is the most targeting medical therapy for residual thyroid tissue. Removing residual thyroid tissue of 131I is not only the first step, but also the base of treating metastases. The significances lie in:1. lower recurrence rate and mortality; 2. Thyroglobulin (Tg) becomes an indicator of recurrence and metastasis of thyroid cancer; 3. it provides the conditions for the treatment of metastases. In view of the importance of removing the residual thyroid tissue, we need study further to improve the targeting treatment's effectiveness.Radioactive iodine uptaken ability is the most critical factor for removal of residual thyroid tissue. Thus, how to increase radioactive iodine uptaken ability in residual thyroid tissue has become the focus of medical workers and scientists now and a large number of animal experiments and preliminary clinical applications showed that lithium carbonate can increase radioactive iodine uptaken ability of thyroid.Objective:The aim of the study is to evaluate the value of lithium carbonate combined with 131I which remove the residual tissue after the ablation of thyroid cancer in clinical application by comparing the results in the experimental group and the control.Materials and Methods:Seventy-four consecutive DTC patients with thyroid remnants are divided into two groups. The first is experimental group, treated by lithium carbonate combined with 131I, in which male are 11 cases, and female 29 cases. Age of the patients is from 10 to 75 and the median age is 45.5. The second is control group, treated only by 131I, in which male are 14 cases and female 20 cases. Age of the patients is from 19 to 74 and the median age is 42. According to the histological criteria categories, all patients can be divided into two categories:63 cases in these patients are thyroid papillary carcinoma and 11 cases are follicular thyroid carcinoma.All patients should routinely be examined FT3, FT4, TSH, Tg, Tg-Ab in the serum, blood routine, liver and kidney function. All patients should also stop taking thyroid hormone and food containing iodine for 3-4 weeks. When these results are consistent with treatment requirements, the first group receive lithium carbonate 250mg ter in die(Tid) for a week and the thyroidal radioiodine uptake(TRIU) should be measured in the before and after taking lithium carbonate. Then, all patients are given therapeutic dose of 131I(100mCi) and whole body imaging is carried out after 5-7 days using SPECT. The pre-treatment of control group is same to the experimental group except for lithium carbonate. All the patients are followed up after 5 months with the same protocol to pre-treatment and they are divided into three categories:cured, effective and ineffective.Results:1. The experimental group (40 patients):Thirty of the 40 cases are cured and ten effective. The total effective rate is 100% and the cure rate is 75%.The control group(34 patients):Fourteen of the 34 cases were cured and twenty effective. The total effective rate was 100% and the cure rate was 41%. The patients of the two groups were not found to be invalid. The results of two groups are analyzed by statistical methods, x2=6.5077, P=0.016<0.05, the difference is statistically significant.2. Thyroidal radioiodine uptake (TRIU) determination results:TRIU of the residual thyroid in the before and after taking lithium carbonate are obviously differenced.2h,4h,24h of TRIU increase 1.45 times,1.48times and 1.67 times respectively in thirty patients of the experimental group. Five in the ten patients of forward peak by taking lithium carbonate reversed.4h/24h ratio is also significantly lower than before taking lithium carbonate. Calculations of effective half-life(Teff) according to the formula Y=-4.555X+9.1697 (X=4h/24hTRIU). Teff of 30 patients taking lithium carbonate is significantly prolonged. Teff are respectively 5.88 days(d),6.37 days(d) in the before and after taking lithium carbonate. Conclusion:1. Lithium carbonate can actually enhance the radioiodine uptaken capacity of the residual thyroid tissue.2. Lithium carbonate can be used to remove the thyroid remnant, improve recovery rate of the removal thyroid tissue and reduce the recurrence rate and mortality of thyroid cancer. |
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