GB 16390-1996 Diagnostic criteria and treatment principles for radiation-induced thyroid disease
Some standard content:
National Standard of the People's Republic of China
Diagnostic criteria and principles of managementfor radiation thyroid diseasesGB 16390--1996
Radiation thyroid disease refers to the primary or secondary thyroid function or/and organic changes caused by the internal and/or external irradiation of ionizing radiation on the thyroid gland or/and other tissues of the body. 1 Subject content and scope of application
This standard specifies the diagnosis and management principles of acute radiation thyroiditis, chronic radiation thyroiditis, radiation hypothyroidism and radioactive benign thyroid nodules. This standard is applicable to workers who are occupationally exposed to ionizing radiation, and non-occupationally exposed workers can also refer to this standard for diagnosis and treatment.
2 Reference Standards
GB16386 Criteria for judging radioactive tumors and principles for treatment 3 Acute radiation thyroiditis Acute radiation thyroiditis refers to local damage to the thyroid gland caused by acute high-dose irradiation in a short period of time and the resulting hyperthyroidism.
3.1 Diagnostic Criteria
3.1.1 History of radiation exposure, thyroid dose of more than 200Gy. 3.1.2-Generally, the disease occurs within two weeks after irradiation.
3.1.3 Local tenderness and swelling of the thyroid gland. 3.1.4 Symptoms and signs of hyperthyroidism, severe cases may present with thyroid crisis. 3.1.5 Increased levels of iodothyronine (T:), serum thyroxine (T,) and thyroglobulin (Tg). 3.1.6 Reference Indicators
3.1.6.1 Decreased white blood cell count.
3.1.6.2 Accelerated erythrocyte sedimentation rate.
3.1.6.3 Lymphocyte chromosome aberration rate and micronucleus rate increased. 3.2 Treatment principles
3.2.1 Avoid continued exposure to radiation or intake of radionuclides to promote the excretion of 1311 in the body. 3.2.2 Symptomatic treatment.
3.2.3 If it turns into hypothyroidism, refer to Chapter 5 for diagnosis and treatment. State Administration of Technical Supervision approved on May 23, 1996 364
1 December 1996 implementation
GB16390--1996
4 Chronic radiation thyroiditis Chronic radiation thyroiditis refers to autoimmune thyroid damage caused by the thyroid gland being exposed to radiation once or multiple times or for a long time within a short period of time (several weeks).
4.1 Diagnostic criteria
4.1.1 History of radiation exposure, thyroid dose of 0.3Gy or more. 4.1.2 The incubation period is more than one year.
4.1.3 The thyroid gland is enlarged, most of which are not tender. 4.1.4 Thyroid microsomal antibodies (Tm-Ab) and/or thyroglobulin antibodies (Tg-Ab) are positive, and thyroid stimulating hormone (TSH) is elevated. 4.1.5 May be accompanied by hypothyroidism. 4.2 Differential diagnosisbzxZ.net
4.2.1 Primary chronic lymphocytic thyroiditis. 4.2.2 Simple goiter, thyroid adenoma, etc. 4.3 Treatment principles
4.3.1 Get rid of radiation, supplement thyroid preparations, and add corticosteroids when necessary. 4.3.2 Combined hypothyroidism shall be treated in accordance with Chapter 5. 5 Radiation hypothyroidism Radiation hypothyroidism refers to hypothyroidism caused by local thyroid gland exposure to high doses once or multiple times in a short period of time (several weeks) or long-term whole-body irradiation exceeding the dose equivalent limit. 5.1 Diagnostic criteria
5.1.1 History of radiation exposure, thyroid dose of more than 10Gy. 5.1.2 Latent period: months, years or even decades after exposure. 5.1.3 Serum T3, T. After several examinations, it is lower than normal, TSH is increased (primary) or decreased (secondary). 5.1.4 Reference indicators
5.1.4.1 Thyroid uptake rate is reduced.
5.1.4.2 Thyrotropin-releasing hormone (TRH) stimulation test to determine the location of the lesion. 5.1.4.3 External irradiation of the head, neck and upper chest may be accompanied by radiation skin damage and radiation oral mucosal damage. 5.1.4.4 Increased lymphocyte chromosome aberration rate. 5.2 Classification
5.2.1 Subclinical hypothyroidism: also known as latent or biochemical hypothyroidism, characterized by only laboratory test changes and no obvious clinical symptoms and signs. 5.2.2 Clinical hypothyroidism: In addition to laboratory test changes, there are obvious symptoms and signs of hypothyroidism. 5.3 Differential diagnosis
5.3.1 Iodine deficiency hypothyroidism. 5.3.2 Congenital hypothyroidism. 5.3.3 Hypothyroidism caused by other factors. 5.3.4 Low T, T. syndrome.
5.4 Treatment principles
5.4.1 Subclinical hypothyroidism: Closely observe the condition, review once a year (nuclide imaging examination is prohibited), and those with persistently elevated TSH and blood lipids are given thyroid replacement therapy and temporarily separated from radiation. After recovery, they can continue to engage in radiation work. 5.4.2 Clinical hypothyroidism: Separation from radiation, thyroid replacement and auxiliary treatment, regular review every year, after recovery, they can continue to engage in radiation work, and those who continue to not recover will receive lifelong replacement therapy. 365
GB16390—1996
6 Radiation benign thyroid nodules Radiation benign thyroid nodules refer to nodular lesions induced by thyroid tissue being irradiated with a large dose or a long-term dose exceeding the limit.
6.1 Diagnostic criteria
6.1.1 Clear history of radiation exposure, thyroid dose of more than 0.2Gy. 6.1.2 Latent period of more than 10 years.
6.1.3 Benign nodules are determined by comprehensive physical, pathological and clinical laboratory tests. 6.1.4 Reference indicators
6.1.4.1 Nodules can become smaller after treatment with thyroid preparations. 6.1.4.2 Increased chromosomal aberration rate in peripheral blood lymphocytes. 6.2 Differential diagnosis
6.2.1 Iodine-deficient thyroid nodules.
6.2.2 Thyroid nodules caused by other factors. 6.2.3 Thyroid tumors.
6.3 Treatment principles
6.3.1 After radiation, thyroid preparations should be used for treatment and annual reexamination (radionuclide imaging examination is prohibited); patients with cancer should undergo surgical resection and be treated as radiation thyroid cancer.
6.3.2 Patients with combined hypothyroidism should be treated in accordance with Chapter 5. 7 The diagnosis and treatment principles of radiation thyroid cancer shall be implemented in accordance with GB16386. 366
A1 Thyroxine, T4
GB16390-1996
Appendix A
Terms of use
(Supplement)
Its chemical structure is 3,5,3',5°-tetraiodothyronine, which has a wide range of physiological effects, affecting the growth and development of the body, tissue differentiation, material metabolism, and the functions of multiple systems and organs. T in circulating blood. Secreted by the thyroid gland. The hormone secreted by the thyroid gland is mainly T, accounting for about 90% of the total, and the daily secretion of adults is 77~110μg. Serum total thyroxine (TT4) includes bound and free T4, and free thyroxine (FT) is only free T in the blood. The two can be converted to each other to maintain dynamic balance. The bound state cannot enter peripheral tissues, pituitary gland and hypothalamus. Therefore, it is believed that the bound state needs to be converted to free state before entering cells to work. In addition, FT. The measurement is not affected by the change of thyroid hormone binding globulin (TBG) concentration, which can more accurately reflect the function of the thyroid gland. Serum TT. is 65~165nmol/L, and FT. is 32.5±6. 5 pmol/L.
A2 triiodothyronine triiodothyronine, T3 Its chemical structure is 3,5,3'-triiodothyronine, and its physiological effect is the same as T. The content in the blood is very small, but the biological activity is strong, equivalent to 3 to 5 times that of T. It is the main component that promotes energy synthesis. Among all the effects of thyroid hormones, T plays about 60% of the role, of which 50% comes from T3 produced by T4. 25% of T in the circulating blood is secreted by the thyroid gland, with a daily secretion of 6μg; about 75% is secreted in peripheral tissues through T.Deiodination conversion. Serum total Ts (TT:) and free T3 (FT:) concentrations are measured by RIA method. The reference value for normal adults is 1.8~2.9 nmol/L for TT: and 6.0~11.4 pmol/L for FT. A3 thyrold stimulation hormone, TSHTSH, is a glycoprotein hormone secreted by the anterior pituitary gland. It acts on thyroid follicular epithelial cells to promote the synthesis and secretion of thyroid hormones. There are two main methods for determination:
a. RIA method, which has poor sensitivity and can only give an upper limit of the normal value for adults <10mIU/L. Values above this value are hypothyroidism; b. Immunoradiometric analysis (IRA) method, which has high sensitivity and a reference value for normal adults of 0.25~5.75mIU/L. An increase is hypothyroidism and a decrease is hyperthyroidism.
A4 TSH stimulating test TRH stimulating test is a method to detect the function of the hypothalamus-pituitary-thyroid axis. First, the serum TSH value is measured on an empty stomach as the pre-stimulation value, and then TRH300μg is injected intravenously. Blood is taken at 15, 60 and 120 minutes to measure the serum TSH concentration as the post-stimulation value. The time-TSH concentration curve is drawn to analyze the reaction type and its clinical significance. The TSH increase (△TSH) is obtained by subtracting the pre-stimulation value from the post-stimulation value. In normal reaction, ATSH is between 13~40μIU/mL, and the peak time is 30 minutes, which can exclude hyperthyroidism or hypothyroidism; increased reaction, TSH>40μIU/mL, is primary hypothyroidism; low and weak reaction, △TSH<13μIU/mL, is pituitary hypothyroidism, and the delayed reaction peak appears after 30 minutes, which is hypothalamic hypothyroidism. A5 Thyroid uptake test is a method to check the thyroid gland's ability to absorb inorganic iodine. Na131I74kBq is taken orally on an empty stomach. Radioactivity in the anterior neck is measured at 2, 4, 6, and 24 hours. The uptake rate is calculated and a time-uptake rate curve is drawn. The thyroid function status is evaluated in the form of the curve and data. The normal value varies depending on the water quality, diet, living habits, and measurement conditions in different places. The results of the normal population in the region in recent years should be used as the basis for evaluation. A6 Thyroglobulin antibody (Tg-Ab) and thyroid microsomal antibody (Tm-Ab) Tg-Ab and Tm-Ab are both thyroid autoantibodies. The determination of their serum concentration is of great significance for the diagnosis and follow-up evaluation of autoimmune thyroid diseases such as chronic lymphocytic thyroiditis. RIA is commonly used, and solid phase separation or double antibody separation technology can be used. Different methodological designs have different judgment criteria. For example, when Tm-Ab is separated by double antibodies, <20% is negative and ≥20% is positive; Tg-Ab is negative and ≥30% is positive. When Tg-Ab is separated by solid phase, the ratio of the patient count P to the normal person count N (i.e. P/N) ≥2.1 is positive.
A7 Thyroglobulin, Tg is a macromolecular glycoprotein synthesized by thyroid cells, with a molecular weight of 680,000. Under normal circumstances, a trace amount enters the blood circulation. When the thyroid gland is cancerous, inflamed or damaged, a large amount of it can enter the blood, increasing the amount of Tg in the blood. The normal reference value for adults measured by serum RIA method is 7.5 ± 4.1 ug/L.
Appendix B
Instructions for the correct use of this standard
(reference)
B1 The diagnosis and treatment of radiation thyroid disease is a multi-professional, technical and policy-oriented work. Therefore, this standard should be carefully implemented by the radiation sickness diagnosis team.
B2 The thyroid dose values listed in this standard are reference values for the lowest doses that cause thyroid damage. Additional notes:
This standard was proposed by the Ministry of Health of the People's Republic of China. This standard was drafted by the Preventive Medicine College of Bethune Medical University and the Third Clinical College of Bethune Medical University. The main drafters of this standard were Jin Yuke, Xiao Yanling, Wang Mingdong, Gong Enjia, and Gao Fengchu. This standard was interpreted by the Ministry of Health's Industrial Hygiene Laboratory, the technical unit entrusted by the Ministry of Health. 368
Tip: This standard content only shows part of the intercepted content of the complete standard. If you need the complete standard, please go to the top to download the complete standard document for free.