【Rationale】.
DTC common lung metastases and bone metastases, metastatic lesions still have NIS expression, about 2/3 of metastatic lesions ingest 131I. after thyroidectomy, 131I emits beta radiation, which can stabilize, shrink or even disappear, especially lung metastases.
Indications]
1.131I whole body scan confirms lung metastasis or bone metastasis by 131I.
2.Response to 131I treatment or stable disease.
3.Regardless of whether the brain metastases take 131I or not, surgical or external irradiation treatment is generally adopted.
Contraindications
1.Pregnancy, lactation.
2.Severe hepatic and renal insufficiency.
3.Leukopenia, WBC <3.0×109 /L.
Method and procedure
1.Diagnosed with lung or bone metastasis or other sites of metastasis;
2.Not taking levothyroxine sodium for 3~4 weeks, those who have already taken it need to stop taking it for 3~4 weeks, no enhanced CT within the last month.
3.Patients sign the informed consent form.
4.Record the present medical history, relevant departments for complete medical record writing, nuclear medicine department according to the number of patients to order drugs in advance, notify patients to come to the designated time to take drugs.
5.Safety education by the nurse practitioner in charge, including taking 131I medication, hygiene, general knowledge of protection, etc.
6.The recommended dose is 150~200mci, which is dispensed by automatic dispenser, and patients are instructed to learn how to take 131I orally before taking the medication.
9. Check the patient’s name, drug name, dosage, medication time and usage according to the medical prescription. The whole process of taking medication is managed by video, and real-time guidance is given to help when necessary.
10.Throw the cup of water after taking medication in the red garbage bag container and put it in the decay box to decay.
11.After taking the medication, observe at least 48 hours in the isolation ward, with video monitoring throughout the whole process, equipped with a telephone to talk when necessary.
12.Start levothyroxine sodium on the 3rd day, starting with a small dose and gradually increasing to the target dose of 2.1μg/kg by body weight.
13.A 131I whole body scan was performed one week later.
【Complications】.
1.Headache, nausea, vomiting, etc.
2.Local neck edema, swelling and pain.
3, radioactive salivary glanditis, can be alleviated by oral VC, etc. to promote salivary gland secretion.
4.reversible decrease of white blood cells and platelets;
5, gonadal damage, pulmonary fibrosis, etc., common in the treatment of multiple high-dose patients.
Efficacy test
1.The course of treatment every 6 months, before and after the treatment of the relevant imaging examination for comparative assessment;
2. Routine 131I whole-body scans were performed 1 week after each treatment to compare the lesion changes;
3. Observe the change of Tg.
Precautions]
1, multiple high-dose application should pay attention to the occurrence of complications, timely treatment;
2. Radionuclides are expensive and decaying, once ordered, they cannot be returned or exchanged, so please inform us in advance if you do not come for treatment on time, otherwise the cost of the drug will be deducted.