問題詳情

125. 一位28歲男性病人接受雙側甲狀腺全切除手術, 其病理報告如下:左側甲狀腺有4*2.2*1.8公分甲狀腺乳突癌,右側甲狀腺無癌病變。左側level II, III, IV淋巴結共切除11個,其中5個有甲狀腺乳突癌轉移。請問有關這位病人的診斷與處置,哪一項正確?
(A) 依據美國聯合癌症委員會(American Joint Commiottee on Cancer staging), 此病人為T2N1bMx,stage IVA
(B) 病人的再發風險高,手術後二週內應該給予放射性碘(I -131)治療
(C) 使用放射性碘治療前,應該先以低劑量(3mCi)放射性碘掃描,以了解殘餘甲狀腺組織有多少並估算適當的放射性碘治療劑量
(D) 病人在接受放射性碘治療後,應該補充甲狀腺素 以維持其甲狀腺功能在subclinicalhyperthyroidism的範圍
(E) 血清中thyroglobulin可做為甲狀腺癌追蹤指標,最好維持在10 ng/ML 以下 (正常參考值< 55 ng/mL)

參考答案

答案:D
難度:計算中-1
書單:沒有書單,新增

用户評論

【用戶】.

【年級】大三上

【評論內容】(D)正確,應保持低TSH level Because most tumors are still TSH-responsive, levothyroxine suppression of TSH is a mainstay of thyroid cancer treatment. Although TSH suppression clearly provides therapeutic benefit, there are no prospective studies that define the optimal level of TSH suppression. The degree of TSH suppression should be individualized based on a patient’s risk of recurrence. It should be adjusted over time as surveillance blood tests and imaging confirm absence of disease or, alternatively, indicate possible residual/recurrent cancer. For patients at low risk of recurrence, TSH should be maintained in the lower normal limit (0.5–2.0 mIU/L). For patients either at inter- mediate or high risk of recurrence, TSH levels should be kept to 0.1 to 0.5 mIU/L and <0.1 mIU/L, respectively, if there are no strong contraindications to mild thyrotoxicosis. TSH should be <0.1 mIU/L for those with known metastatic disease.