Three years ago continental guidelines were published referring management and follow-up of low risk thyroid cancer patients. The aim of this paper is to summarize the changes and new directions in this field. High risk patients require another protocol. Neck ultrasound plays important role in differential diagnosis and in detecting recurrences. Some new ultrasound techniques are discussed, too. FDG-PET can help to solve the problem of patients having negative scan and increased thyroglobulin level. In recent years there was an expansion of our knowledge about the pathomechanism of thyroid cancer. It appears that genetic alterations frequently play a key role in carcinogenesis. There are molecular methods that allow the detection of these genetic events in thyroid fine needle aspirations samples providing important information for diagnosis, management and prognosis. Instead of diagnostic whole body scanning the posttherapeutic scan became preferable but in high risk cases the diagnostic whole body scintigrams serve useful data. Primary therapy of thyroid cancer is an adequate surgery: total thyreoidectomy and, if necessary, lymph node dissection or limited surgery in selected cases. Nowadays radioguided surgery can help to improve the results. Radioiodine therapy (e.g. rest ablation) proved to be a safe and effective method to complete surgery. It can prevent relapses and results in longer survival. Thyroid hormone withdrawal or recombinant human thyrotropin stimulation can increase thyrotropin level before radioiodine treatment. These two methods have similar success rate of rest ablation but irradiation burden of blood is lower in the case of exogenous stimulation which avoids hypothyroid state and preserves quality of life. Since tumor cells fail to maintain the ability to perform physiological functions they undergo dedifferentiation. Therefore, an important aim is to reactivate some function of differentiated cells, e.g. iodine uptake, production of thyroperoxydase and thyroglobulin. Opportunities for this therapeutic effort are also mentioned. Restoration of iodine uptake enables radioisotope treatment. Until now there has been little interest in the development of new drugs for the treatment of thyroid cancer. However, advances in our understanding of tumor cell biology will lead to a paradigm shift in the therapy that is likely to benefit patients who have high risk disease and who do not almost have any therapeutic option. There are new drugs in clinical trials that appear to be more effective than earlier cytotoxic agents. Probably modern chemotherapy of advanced thyroid cancer will have significant results in the near future.
In the future somewhat more radical surgery and less remnant ablation is needed with unified follow-up protocol.
A benignus és malignus pajzsmirigybetegségek radiojódkezelését körülbelül 70 éve vezették be, mindemellett a kezelés az indikáció, a dózis és az eljárás tekintetében a konszenzus hiányával jellemezhető. Az összefoglaló foglalkozik az immunogén hyperthyreosis kezelésének eredményeivel, beleértve az endokrin orbitopathia problémáját. Tárgyalja a toxikus és nem toxikus multinodularis strúma radiojódkezelését, hangsúlyozva a jódfelvétel növelésének jelentősé-gét. Ebben a vonatkozásban a rekombináns humán tireotropin alkalmazását szükséges említeni. A pajzsmirigyrák kezelési protokollja is változott, a kis kockázatú betegeken a kezelés ineffektív, szükségtelen. Több figyelmet érdemel a radiojód carcinogen hatása. Számos említett probléma jól megtervezett, prospektív tanulmányokat igényel, hogy az alapvető problémák tisztázódjanak. A szerző hangsúlyozza: a radiojódterápia megválasztásánál a még megfelelően hatékony, legalacsonyabb dózisra kell törekedni. Orv. Hetil., 2016, 157(3), 83-88. Kulcsszavak: jóindulatú pajzsmirigybetegségek, pajzsmirigyrák, radiojódterápia változásai Changes in radioiodine therapy for thyroid disordersRadioiodine therapy for benign and malignant thyroid diseases was introduced about 70 years ago, however, there is still a lack of consensus regarding indications, doses and procedure. This review covers treatment results in immunogenic hyperthyroidism including the problem of orbitopathy. Radioiodine therapy for toxic and non-toxic multinodular goiter is also discussed with striking possibility of enhanching the radioiodine uptake. In this respect the recombinant human thyrotropin should be mentioned. Thyroid cancer treatment protocol has changed, too, due to ineffectivity in low-risk patients. More attention is needed to the carcinogenecity of radioiodine. The numerous problems mentioned above require large and well-designed prospective trials to resolve the fundamental questions. The author emphasizes that radioiodine dose should be administered in doses as low as reasonably achievable. Keywords: benign thyroid diseases, thyroid cancer, changes of radioiodine therapyKonrády, A. [Changes in radioiodine therapy for thyroid disorders]. Orv. Hetil., 2016, 157(3), 83-88. (Beérkezett: 2015. október 6.; elfogadva: 2015. november 5.) ÖSSZEFOGLALÓ KÖZLEMÉNYRövidítések aTPO = peroxidáz elleni antitest; BG-kór = Basedow-Gravesbetegség; DTC = differenciált pajzsmirigyrák; EOP = endokrin orbitopathia; hTG = humán tireoglobulin; NIS = nátrium-jodid-szimporter; rhTSH = rekombináns humán tireotropin; TRAb = tireotropinreceptor-antitest A pajzsmirigybetegségek jódizotópos kezelésének törté-nete csaknem háromnegyed százados, 1942-ben kezdő-dött [1]. Először a jód 130-as izotópját alkalmazták, majd uralkodóvá vált a béta-és gamma-sugárzó 131-es izotóp ( 131 I). A múlt század '70-es éveiben kísérletek történtek a 125 I alkalmazásával is, amelynek kedvező fizikai tulajdonságai alapján jó eredményeket vártunk, de a klinikai gyakorlat a várakozásokat nem igazolta. Ma már csak a jód 131-es izotópját használjuk.Év...
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