| Differentiated thyroid carcinoma (DTC) is derived from thyroid follicular cells and has different differentiation and different degrees of malignancy. DTC's pathological type include papillary carcinoma, follicular carcinoma and two mixed type, DTC is often seen in thyroid cancer and accounts for more than 90% of thyroid cancer. DTC's cells to retain the whole or part of function of iodide uptake of normal thyroid cell and regulated by TSH and other physiological functions, and also known as functional thyroid cancer. In recent years, the incidence of DTC increased significantly and DTC has a wide range of geographical distribution. About the treatment of DTC, the comprehensive treatment, surgical+131 I+thyroxine suppression can reduce the rate of recurrence and improve the rate of survival significantly.DTC follow-up in the course of treatment, nuclear medicine physicians often encounter about 1/3 131I-WBS-negative patients, but through other tests such as serum Tg, PET, ultrasonography, CT and clinical examination revealed recurrence of metastasis are still there. Clinically, the most common cause is the loss of DTC differentiation, loss of differentiated tumor cells more invasive, is an important prognostic reasons. Loss of differentiated cell morphology and function of DTC are degenerative changes occur, such as the receptor (TSHR) expression ability of obstacles and the loss of iodine uptake, 131I and T4 to suppress treatment are impossible.Inducing re-differentiation is to enable DTC's cells to re-differentiation and make it has normal function.Retinoic acid (RA), a kind of vitamin A metabolite of thyroid cells has the biological activity of vitamin A and can inhibit a variety of cancer cell proliferation and induce cell differentiation and apoptosis. RA and its receptors control the capacity of differentiation, proliferation and apoptosis and play important role in there aspects.Re-differentiation therapy with RA in DTC is recent focus of research.Objective To evaluate the all-trans retinoic acid (ATRA) inducing re-differentiation therapy of DTC which has recurrence or metastatic lesions without ability of differentiation which 131I and T4 suppression therapy.Materials and Methodsall 23 DTC patients and pathologically confirmed, in which 18 cases of papillary carcinoma (PTC),3 cases of follicular carcinoma (FTC),and 1 case of mixed type, and 1 case of poorly differentiated type. Oral ATRA 20mg,3 times a day, continuing medication at least 6 weeks. Oral therapeutic dose of 131I 5-7 days after whole body imaging. Comparison of ATRA before and after treatment, and 131I treatment of metastases after 5 months of 131I uptake changes; using ultrasound, X ray or CT determine the size of metastatic foci; electrochemiluminescence assay sTg, TgAb.Results21 cases of re-differentiation induced by ATRA treatment,7 cases (33.3%)131 I uptake was significantly higher (effective treatment group),10 patients (42.9%) slightly increased uptake of Iodine Uptake of lesions can be diagnosed in 4 cases (19.1%) No change.8 cases (38.1%) found the iodine uptake of new lesions; induced Differentiation of serum Tg determination results after treatment,15 cases of induced re-differentiation therapy sTg measurements, Increased in 9 cases (60.0%); no change in 4 cases (26.7%), decreased in 2 cases (13.3%).5 months after 131I treatment of tumor size and the comprehensive test before treatment of 13 patients,4 cases (30.7%) reduced, in 6 cases (46.2%) had no change,3 patients (23.8%) increased.Conclusion1.Re-differentiation induced by ATRA treatment, some patients can restore or increase the loss of differentiated cells Iodine Uptake and thus feasible to 131I therapy.2.Re-differentiation induced by retinoic acid treatment,131I whole body scan can improve the diagnosis of DTC's lesions positive rate.3.Re-differentiation induced by retinoic acid treatment of DTC's lesions is an effective method, less adverse drug reactions.
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