I. Indications
1. Those with lymph node metastasis in the neck
2.Distant metastasis such as mediastinal lymph node metastasis, lung metastasis, bone metastasis, brain metastasis, etc.
3.The mass is found to have adhesions with normal tissues or vascular cancer thrombus during surgery
4.The diameter of the primary focus is greater than 4 cm
5.There is perineural invasion of the thyroid gland.
6.The mass breaks through the envelope 7.With multiple foci
8.Invasive type (such as high columnar)
II. Preparation before treatment
1.First treatment (nail clearing treatment)
Forbid iodine for 4 weeks, stop using eugenol for 4 weeks or TSH more than 30. If you are going to do iodine 131 treatment after surgery, it is recommended not to give eugenol or thyroxine tablets after surgery.
Also, never do CT enhancement within 6 weeks before iodine 131 treatment, remember!!!
2.Multiple treatments (metastases treatment)
Forbid iodine for 4 weeks, stop eugenol for 3 weeks or TSH more than 30
3.The main iodine-containing foods prohibited before treatment include: freshwater fish, sea fish, seafood, seaweed, nori, hairy vegetables, eggs, fresh milk, herbal tea, cola.
4. Information to be provided before hospitalization (copies)
(1) Pathology report form (must be provided)
(2) Surgery records
(3) Post-surgical discharge summary (must be provided)
(4) Other examinations (such as B ultrasound, ECT, PET, CT, etc.)
Third, the dose of treatment judgment
1.Clear nail: 100-150mci
2.Lymph node metastasis in the neck: 150-200 mci
3.Mediastinal lymph node metastasis: 200-230 mci
4.soft tissue invasion of the neck: 180-230 mci
5.Pulmonary metastasis: 200-250 mci
6.Bone metastasis: 250-299 mci
Continued iodine prohibition for four weeks after treatment
IV. Interval of treatment.
The interval between nail clearance and the first treatment of metastases is 3 months, and the interval between the second treatment of metastases is 6 months.
V. Decision on the number of treatments
All patients who meet the above indications will be treated after nail clearance. If the lesions are still present after four focal clearance treatments, the treatment time will be extended to once every 1-2 years.
Follow up
1. Patients who are not cured
The first month and the third month after the treatment are followed up once each, and the first month, the eight items of nail function, blood routine, liver function and electrolytes are checked. In the third month, the ultrasound of the neck should be added. In the sixth month, stop the drug and prohibit iodine for treatment.
2.Cured patients
The first month and the third month after the treatment, follow up each time. The first month, check the eight items of nail function, blood routine, liver function and electrolytes. In the third month, check the ultrasound of the neck. In the sixth month, stop the drug and prohibit iodine for a comprehensive examination.
If the above three cycles are repeated and all of them are normal, the period of examination will be extended to one year: one follow-up visit in the first month and one in the sixth month. In the first month, check the eight items of nail function, blood routine, liver function and electrolytes. Ultrasound of the neck is added in the sixth month. In the 12th month, stop the drug and prohibit iodine for a full examination. If three consecutive times are normal, it will be changed to a three-year cycle.