In a popular science lecture on 10.23, Professor Zhu Jingqiang from West China Hospital gave a very professional and detailed explanation on the standardized treatment and follow-up of differentiated thyroid cancer (DTC). So in the background, there are many friends A asking Xiaoi for the lecture notes for this lecture, so Xiaoi naturally has to arrange it for everyone!
Lecture Topic: Postoperative Standards, "risk" and worry-free
- Standardized management, reduce recurrence
Everyone knows that although differentiated thyroid cancer is "happy cancer", it is not "one and all". You can rest assured after the operation.
On the contrary, within ten years after the operation, it will still recur due to various reasons (individual differences in the condition itself, patient failure to follow-up, failure to take medication according to doctor's advice, etc.).
Therefore, the Thyroid Surgeons Committee of the Surgeons Branch of the Chinese Medical Association pointed out that standardized postoperative treatment and follow-up are the key to reducing patient recurrence rates and improving survival rates. They also undoubtedly become the two major focus of differentiated thyroid cancer (DTC).
Key 1: The standardized treatment of DTC "trilogy"
Professor Zhu Jingqiang called surgical treatment, TSH inhibition treatment, and postoperative iodine 131 treatment trilogy of differentiated thyroid cancer (DTC).
. Surgery
surgery is the most important link in DTC treatment. It directly affects the prognosis of DTC patients including local recurrence, overall recurrence, and patient survival rate, and will also affect the formulation of postoperative treatment and follow-up plans for patients.
.TSH inhibition treatment
TSH inhibition treatment is not only the reduction of DTC recurrence rates in our usual cognition, it can also improve the survival rate of DTC patients and improve the quality of life of patients. Studies have shown that L-T4 treatment (TSH inhibition therapy) reduces the postoperative recurrence rate of DTC (≥1.5 cm) by as much as 18%.
Professor Zhu Jingqiang talked about the Youjiale replenishment strategy that friends of A are very concerned about. Because the half-life of L-T4 is as long as 7 days, it not only makes it possible to take at one time, but also makes replenishment after missed taking, making the blood drug concentration relatively stable. Therefore, after L-T4, you can take double doses for replenishment the next day. If you missed the dose for more than one day, you should insist on taking double doses for multiple days until you have enough doses for missed.
At the same time, Professor Zhu Jingqiang also mentioned the problem of taking medication on the day of the reexamination, because although taking L-T4 before blood draw has little effect on serum TSH, it has an impact on serum FT4 levels. Therefore, it is recommended to take L-T4 or take the medicine for 6 hours after taking the blood test on the day of the reexamination, and try to keep it for about the same time each time.
. Iodine 131 treatment for
Iodine 131 treatment is mainly for patients with differentiated thyroid cancer (DTC) who have a risk of recurrence stratified into medium and high-risk postoperative patients, and is a routine recommendation for high-risk patients. According to the different doses of iodine 131, it can achieve two purposes:
clearing: 131I clearing the residual thyroid tissue after the operation; 131I clearing: 131I clearing the DTC metastasis that cannot be removed
Its role is mainly reflected in three aspects. The first thing is to remove the normal and cancerous thyroid tissue that is left or cannot be removed by surgery, so as to eliminate potential lesions to alleviate the condition and improve the prognosis; secondly, it can also eliminate interference from residual thyroid tissue, which is conducive to postoperative follow-up monitoring; and it can also guide subsequent treatment and follow-up.
Its effect on the reduction of recurrence rate and improvement of survival rate in patients after DTC surgery is also proved:
Keywords 2: Standardized follow-up after DTC surgery should be paid attention to
. Meaning
The significance of standardized follow-up after surgery is mainly the following four types:
① Monitor recurrence and metastasis
② Dynamic observation of the progress of the disease and treatment effect
③ Monitor the effect of TSH inhibition treatment
④ Dynamic observation (such as cardiovascular disease, etc.) The concomitant disease condition of DTC patients
. The duration and frequency of follow-up
Guidelines suggest that long-term follow-up should be conducted for DTC patients. The frequency is TSH treatment standards once every 2 to March, once every 2 months within two years, and once every 6 to 12 months within five years.
Friends can simply remember it as at least three months, six months, or once a year.
. Daily health management is the basis of follow-up management
Professor Zhu Jingqiang emphasized that daily health management is the basis of follow-up management.
For daily health management during DTC follow-up, comprehensive health management should be carried out based on the full assessment of the patient's individual health risks. The intervention measures include nutrition, diet, exercise, psychology and other levels.
includes nutritional nutritional care for vitamins, minerals, high-quality protein intake, maintaining a healthy weight; dietary restrictions on alcohol, appropriate amounts of sugar, and ensuring drinking water; exercise three moderate-intensity aerobic training, two aerobic plus resistance training combined training, etc.
What should I do if it relapses?
In the lecture, Professor Zhu Jingqiang also mentioned the treatment strategy for DTC recurrence or metastasis, which is roughly divided into two directions: surgery/no surgery, of course, surgical treatment is preferred.
, especially recurrent or metastatic lesions that have been confirmed by pathological examinations or are highly suspected by imaging, require supplementary total thyroidectomy + therapeutic central and/or lateral cervical lymph node dissection to completely clear the lesions and retain the function of important organs.
. For a small number of small recurrent metastatic lymph nodes (suspicious metastatic lymph nodes in the central area 8 mm and lateral cervical area 10 mm), follow-up observation can be performed.
If there are contraindications for surgery or the patient refuses surgery, you can also choose iodine 131 treatment, minimally invasive treatment, external radiation therapy, targeted treatment and other treatment methods, but of course the first choice is surgery.
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*This article is compiled based on expert lectures and reflects the personal opinions of experts and is for reference only. Specific follow-up and health management measures vary from person to person. Friend A is advised to follow the opinions of his attending doctor.
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