DATHYRCA guidelines - Dahanca

Guidelines - Thyreoideacancer – revideret oktober 2005
Formål............................................................................................................................................................27
Radiofysik.......................................................................................................................................................27
Farmakokinetik...............................................................................................................................................27
Effekt af radiojodbehandling efter primær kirurgisk intervention..................................................................28
Effekt af radiojodbehandling for metastaserende sygdom..............................................................................28
Forholdsregler i forbindelse med I-131 .........................................................................................................28
Jodfattig diæt..................................................................................................................................................28
PRAKTISK GENNEMFØRELSE AF BEHANDLING MED I-131................................................................................ 29
Diagnostisk skintigrafi før terapidosis ...........................................................................................................29
Første terapidosis...........................................................................................................................................29
Graviditet og amning......................................................................................................................................29
Dosering.........................................................................................................................................................29
THYREOGLOBULIN ............................................................................................................................................ 30
STRATEGI EFTER ABLATIONSDOSIS MED I-131 (FLOW-CHART)....................................................................... 31
TOKSICITET AF I-131......................................................................................................................................... 33
Akutte komplikationer.....................................................................................................................................33
Kvalme/opkastning .........................................................................................................................................33
Akut sialoadenitis ...........................................................................................................................................33
Knoglemarvssuppression................................................................................................................................33
Infertilitet og teratogenicitet...........................................................................................................................33
Leukæmi .........................................................................................................................................................33
Andre sekundære maligne lidelser .................................................................................................................33
FORHOLDSREGLER VED AKUT OPERATION ELLER DØD EFTER RADIOTERAPI AF PATIENT MED I-131........... 34
Akut operation eller obduktion.......................................................................................................................34
Begravelse/kremering.....................................................................................................................................34
FORHOLDSREGLER VED UHELD EFTER RADIOJODBEHANDLING AF PATIENT.................................................. 34
EKSTERN STRÅLEBEHANDLING AF PAPILLÆRE OG FOLLIKULÆRE THYREOIDEAKARCINOMER.................... 34
Indikationer ....................................................................................................................................................35
Target og fraktionering ..................................................................................................................................35
EKSTERN STRÅLEBEHANDLING AF ONKOCYTÆRT KARCINOM ........................................................................ 36
EKSTERN STRÅLEBEHANDLING AF MEDULLÆRT KARCINOM .......................................................................... 36
EKSTERN STRÅLEBEHANDLING AF UDIFFERENTIERET KARCINOM ................................................................. 36
THYREOIDEACANCER HOS BØRN................................................................................ 37
BEHANDLING ..................................................................................................................................................... 37
EFTERBEHANDLING........................................................................................................................................... 37
KONTROL EFTER AFSLUTTET BEHANDLING .......................................................... 38
PAPILLÆRT OG FOLLIKULÆRT KARCINOM ...................................................................................................... 38
Kontrol af patienter behandlet for papillært eller follikulært karcinom undtaget unifokale papillære
mikrokarcinomer ............................................................................................................................................38
Strategi under follow-up.................................................................................................................................38
Strategi uden anvendelse af TSH-stimulation.................................................................................................39
Strategi med involvering af TSH-stimulation .................................................................................................39
Kontrol af patienter behandlet for papillært mikrokarcinom.........................................................................42
Rekombinant human thyreoidea stimulerende hormon (rhTSH) ....................................................................42
MEDULLÆRT KARCINOM .................................................................................................................................. 42
Mutationsundersøgelse...................................................................................................................................42
Kontrol af patienter behandlet for ikke arvelig medullær thyreoideacancer .................................................42
Kontrol af patienter med arvelig medullær thyreoideacancer .......................................................................44
UDIFFERENTIERET KARCINOM ......................................................................................................................... 44
SUPPRESSIONS OG SUBSTITUTIONSBEHANDLING.............................................................................................. 44
Suppressionsdosis...........................................................................................................................................45
Substitutionsdosis ...........................................................................................................................................45
GENETISK UDREDNING OG BEHANDLING AF ARVELIG MEDULLÆR
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