GBZ 101-2002 Diagnostic criteria for radiation-induced thyroid disease

This standard specifies the diagnosis and treatment principles for 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. Non-occupationally exposed workers can also refer to this standard for diagnosis and treatment. GBZ 101-2002 Diagnostic Standard for Radiation Thyroid Diseases GBZ101-2002 Standard Download Decompression Password: www.bzxz.net

ICS13.100
National Occupational Health Standard of the People's Republic of China GBZ101-2002
Diagnostic criteria for radiation thyroid diseases
Diagnostic criteria for radiation thyroid diseases2002-04-08 Issued
Implemented on 2002-06-01
Ministry of Health of the People's Republic of China
3.1, 4.1, 5.1, 6.1 of this standard are mandatory, and the rest are recommended. GBZ101-2002
This standard is specially formulated in accordance with the Law of the People's Republic of China on the Prevention and Control of Occupational Diseases. In case of any inconsistency between the original standard GB16390-1996 and this standard, this standard shall prevail.
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 to the thyroid gland or/and other tissues of the body. Appendix A of this standard is a prescriptive appendix.
This standard is proposed and managed by the Ministry of Health of the People's Republic of China. This standard was drafted by the School of Preventive Medicine of Bethune Medical University and the Third Clinical School of Bethune Medical University. The main drafters of this standard are Jin Yuke, Xiao Yanling, Wang Mingdong, Gong Enjia, and Gao Fengtong. This standard is interpreted by the Ministry of Health of the People's Republic of China. 2
1 Scope
Diagnosis of radiation-induced thyroid diseases
GBZ101-2002
This standard specifies the diagnosis and treatment 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 Normative references
The clauses in the following documents become the clauses of this standard through reference in this standard. All subsequent amendments (excluding errata) or revisions of dated references are not applicable to this standard. However, parties that reach an agreement based on this standard are encouraged to study whether to use the latest versions of these documents. For undated references, the latest versions apply to this standard. GBZ97: Diagnostic criteria for radioactive tumors
2 Acute radiation thyroiditis
acuteradiationthyroiditis
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 cause thyroid crisis. 3.1.5
Elevated levels of triiodothyronine (T), serum thyroxine (Ta) and thyroglobulin (Tg). 3.1.6 Reference indicators
Decreased white blood cell count.
Erythrocyte sedimentation rate accelerated.
Increased lymphocyte chromosome aberration rate and micronucleus rate. 3.1.6.3
3.2 Treatment principles
3.2.1 Avoid continued exposure to radiation or intake of radionuclides to promote the excretion of 13'1 in the body. 3.2.2 Symptomatic treatment.
3.2.3 For those who develop hypothyroidism, diagnosis and treatment shall be carried out according to Chapter 5. 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 absorbed dose of more than 0.3Gy. 4.1.2 Incubation period of more than one year.
4.1.3 Thyroid enlargement, mostly without tenderness
4.1.4 Positive thyroid microsomal antibodies (Tm-Ab) and/or thyroglobulin antibodies (Tg-Ab), elevated thyroid stimulating hormone (TSH). 4.1.5 May be accompanied by hypothyroidism. 3
GBZ101-2002
4.2 Differential diagnosis
4.2.1 Primary chronic lymphocytic thyroiditis. 4.2.2 Simple goiter, thyroid cancer, etc. 4.3 Treatment principles
4.3.1 Get rid of radiation, supplement thyroid preparations, and add corticosteroids if necessary. 4.3.2 Patients with combined hypothyroidism should be treated according to Chapter 5. 5 Radiation hypothyroidism Radiation hypothyroidism refers to hypothyroidism caused by local thyroid exposure to high doses once or multiple times in a short period of time (several weeks) or long-term whole-body irradiation exceeding the equivalent dose limit. 5.1 Diagnostic criteria
5.1.1 History of radiation exposure, thyroid absorbed dose of more than 10Gy. 5.1.2 Latent period: months, years or even decades after exposure. 5.1.3 Serum T3 and T are lower than normal after several examinations, TSH is elevated (primary) or decreased (secondary). 5.1.4 Reference indicators
Thyroid uptake rate is reduced.
Thyrotropin-releasing hormone (TRH) stimulation test determines the site of the lesion. External irradiation of the head, neck and upper chest may be accompanied by radiation skin damage and radiation oral mucosal damage. Lymphocyte chromosome aberration rate is increased.
5.2 Classification
5.2.1 Subclinical hypothyroidism: also known as latent or biochemical hypothyroidism, characterized by only laboratory test changes without 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 T3, T4 syndrome.
5.4 Treatment principles
5.4.1 Subclinical hypothyroidism: Closely observe the condition and review once a year (nuclides imaging examination is prohibited). Those with persistently elevated TSH and blood lipids should be given thyroid replacement therapy and temporarily away from radiation. After recovery, they can continue to engage in radioactive work. 5.4.2 Clinical hypothyroidism: Avoid radiation, use thyroid preparations for replacement and adjuvant therapy, have regular annual checkups, and continue to work with radiation after recovery. Those who continue to fail to recover will receive lifelong replacement therapy. radiation benign thyroid nodule6 Radioactive benign thyroid nodule
Radioactive benign thyroid nodule refers to nodular lesions induced by thyroid tissue being irradiated with large doses or long-term exposure exceeding the equivalent dose limit
6.1 Diagnostic criteria
6.1.1 Clear history of radiation exposure, thyroid absorbed dose of more than 0.2Gy. 6.1.2 Latent period of more than 10 years.
6.1.3 Comprehensively determined to be benign nodules by physical, pathological and clinical laboratory tests. 6.1.4 Reference indicators:
6.1.4.1 Nodules can become smaller after thyroid preparation treatment. 4
2 Increased chromosomal aberration rate in peripheral blood lymphocytes. 6.1.4.2
6.2 Differential diagnosis
6.2.1 Iodine-deficient thyroid nodules.
6.2.2 Thyroid nodules caused by other factors. 6.2.3 Thyroid cancer.
6.3 Treatment principles
GBZ101-2002
6.3.1 Avoid radiation, use thyroid preparations for treatment, and review once a year (nuclides imaging examination is prohibited): For cancerous changes, surgical resection is performed and treated as radioactive thyroid cancer.
6.3.2 Patients with combined hypothyroidism shall be treated in accordance with Chapter 5. wwW.bzxz.Net
radiation thyroid cancer
The diagnosis and treatment principles shall be implemented in accordance with the reference standard GBZ97. 5
GBZ101-2002
AlThyroxine, T4
Appendix A
(Normative Appendix)
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. T4 in the circulating blood is secreted by the thyroid gland. The hormone secreted by the thyroid gland is mainly T4, 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 (FT4) is only free T4 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, so it is believed that the bound state needs to be converted into a free state before entering the cell to work. In addition, FT4 determination is not affected by changes in the concentration of thyroid hormone binding globulin (TBG), and can more accurately reflect the function of the thyroid gland. Serum TT4 is 65-165nmol/L, and FT4 is 32.5±6.5pmol/L.
A2 triiodothyronine, T3 has a chemical structure of 3,5,3°-triiodothyronine, and its physiological effect is the same as T4. The content in the blood is very small, but the biological activity is strong, equivalent to 3-5 times that of T4. It is the main component that promotes energy synthesis. Among all the effects of thyroid hormones, T3 plays about 60% of the role, of which 50% comes from T3 produced by T4. 25% of T3 in the circulating blood is secreted by the thyroid gland, with a daily secretion of 6μg; about 75% is converted by T4 deiodination in peripheral tissues. The serum total T3 (TT3) and free T3 (FT3) concentrations are determined by RIA method. The normal adult reference value for TT3 is 1.8~2.9nmol/L, and for FT3 is 6.0~11.4pmol/L. A3 thyroid stimulating hormone, TSHTSH, is a glycoprotein hormone secreted by the anterior pituitary gland, which acts on thyroid follicular epithelial cells to promote the synthesis and secretion of thyroid hormones. There are two main determination methods:
a: RIA method, which has poor sensitivity and can only give the upper limit of the normal value for adults <10mIU/L. Values ​​above this value are hypothyroidism: b, immunoradiometric analysis (1RA) method, which has high sensitivity and the normal adult reference value is 0.25~5.75mIU/L. Increased values ​​are hypothyroidism, and decreased values ​​are 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 TRH 300μg 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 a normal reaction, △6
GBZ101-2002
TSH is between 13 and 40uIU/mL, and the peak time is 30 minutes, which can exclude hyperthyroidism or hypothyroidism: an increased reaction, TSH>40μIUmL, is primary hypothyroidism; a weak reaction, △TSH<13μIU/mL, is pituitary hypothyroidism, and a 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. Na131174 kBq is taken orally on an empty stomach. The radioactivity in the anterior neck area 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 method is commonly used, which can use solid phase separation or double antibody separation technology. 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/M) ≥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 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±4.1μg/L.75mIU/L, increased for hypothyroidism, decreased for hyperthyroidism.
A4 Thyrotropin-releasing hormone stimulation 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, then 300μg of TRH is injected intravenously, and blood is drawn 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. Normal reaction, △6
GBZ101-2002
TSH is between 13 and 40uIU/mL, with a peak time of 30 minutes, which can exclude hyperthyroidism or hypothyroidism: high reaction, TSH>40μIUmL, 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 Thyroid uptake test is a method to check the thyroid gland's absorption function of inorganic iodine. Oral Na131174kBq is taken on an empty stomach, and the radioactivity of the anterior neck is measured at 2, 4, 6, and 24 hours. The uptake rate is calculated, and the time-uptake rate curve is drawn. The thyroid function status is evaluated in the form of curves and data. The normal value varies according to the water quality, diet, living habits and measurement conditions of different places. It is advisable to use the results of normal people in the region in recent years 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 concentrations is of great significance for the diagnosis and follow-up evaluation of autoimmune thyroid diseases such as chronic lymphocytic thyroiditis. The commonly used RIA method can use solid phase separation or double antibody separation technology. 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 (ie P/M) ≥2.1 is positive.
A7 Thyroglobulin, Tg is a large molecular glycoprotein synthesized by thyroid cells with a molecular weight of 680,000. Under normal circumstances, a small amount enters the blood circulation. When the thyroid gland is cancerous, inflamed or damaged, a large amount can enter the blood, increasing the amount of Tg in the blood. The normal reference value for adults is 7.5±4.1μg/L as determined by serum RIA method.75mIU/L, increased for hypothyroidism, decreased for hyperthyroidism.
A4 Thyrotropin-releasing hormone stimulation 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, then 300μg of TRH is injected intravenously, and blood is drawn 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. Normal reaction, △6
GBZ101-2002
TSH is between 13 and 40uIU/mL, with a peak time of 30 minutes, which can exclude hyperthyroidism or hypothyroidism: high reaction, TSH>40μIUmL, 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 Thyroid uptake test is a method to check the thyroid gland's absorption function of inorganic iodine. Oral Na131174kBq is taken on an empty stomach, and the radioactivity of the anterior neck is measured at 2, 4, 6, and 24 hours. The uptake rate is calculated, and the time-uptake rate curve is drawn. The thyroid function status is evaluated in the form of curves and data. The normal value varies according to the water quality, diet, living habits and measurement conditions of different places. It is advisable to use the results of normal people in the region in recent years 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 concentrations is of great significance for the diagnosis and follow-up evaluation of autoimmune thyroid diseases such as chronic lymphocytic thyroiditis. The commonly used RIA method can use solid phase separation or double antibody separation technology. 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 (ie P/M) ≥2.1 is positive.
A7 Thyroglobulin, Tg is a large molecular glycoprotein synthesized by thyroid cells with a molecular weight of 680,000. Under normal circumstances, a small amount enters the blood circulation. When the thyroid gland is cancerous, inflamed or damaged, a large amount can enter the blood, increasing the amount of Tg in the blood. The normal reference value for adults is 7.5±4.1μg/L as determined by serum RIA method.
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