Clinical experience of ¹³¹I standard diagnosis and treatment of differentiated thyroid carcinoma in basic hospital

Objectives: To evaluate treatment effect of differentiated thyroid cancer (DTC) in primary hospitals while observing the standardized treatment process and status quo of DTC in Anqing Province, China. Methods: A total of 219 DTC patients [48 males and 17 females, aged between 22 to 68 (44.6 ± 5.4) years old] admitted to our hospital from July 2015 to July 2018 received ¹³¹I treatment. Specifically, these patients stopped taking levothyroxine 3 to 4 weeks before treatment, were given an iodine-free diet, and were administered oral ¹³¹I by DTC individualized dose after examining and excluding any contraindication of the treatment. The clinical treatment effect on patients with different pathological types was then examined, and each patient was checked for metastatic lesions to ensure that no non-standard phenomenon occurred during the treatment. The nuclear medicine discipline and status quo of standardized DTC treatment in primary hospitals and the degree of related knowledge of primary doctors were also examined by conducting a questionnaire survey. The questionnaires were distributed to the participants in the Standardized Treatment and Diagnosis of Nuclear Medicine seminar in Southwest Anhui. Tg was monitored among the follow-up outpatients, and their thyroid function, thyroid iodine uptake rate, and imaging examination results were used to determine the key points. Results: The ¹³¹I treatment achieved an effective rate of 98.6% (216/219) among the DTC patients. A total of 57 cases demonstrated non-standard phenomena, among which 38 cases were cured by ¹³¹I in a secondary operation, 7 were cured via radiotherapy or ¹³¹I treatment after radiotherapy, 8 cases developed cervical lymph node metastases after a partial thyroidectomy operation, 2 cases developed DTC metastases due to limited TSH inhibition, and 2 cases (in other hospitals) developed metastases due to irregular monitoring of Tg or TgAb. The survey results showed that Anqing only has two medical hospitals, and our hospital is the only institution that can administer the ¹³¹I treatment. The number of medical staff in primary hospitals who mastered standardized DTC treatment knowledge was less than 30% (62 of 219). A total of 187 follow-up patients were Tg negative, whereas 32 were Tg positive, thereby indicating a satisfactory control level of TSH among these patients. The thyroid iodine uptake rate of the outpatients was less than 1%, and the imaging examination results of most outpatients were negative. Conclusions: The observation results highlighted a positive standard treatment effect. Although some abnormal phenomena were observed during the course of the treatment, they can be avoided or reduced by strictly implementing the treatment system and strengthening the standardized treatment knowledge of the medical staff. (authors)