{"id":2838,"date":"2020-10-28T19:07:33","date_gmt":"2020-10-28T16:07:33","guid":{"rendered":"https:\/\/www.intheranostics.com\/prof\/?page_id=2838"},"modified":"2020-11-05T00:03:34","modified_gmt":"2020-11-04T21:03:34","slug":"tiroid-kanseri-sp-bg","status":"publish","type":"page","link":"https:\/\/www.intheranostics.com\/prof\/bg\/tiroid-kanseri-sp-bg\/","title":{"rendered":"\u0420\u0430\u043a \u043d\u0430 \u0449\u0438\u0442\u043e\u0432\u0438\u0434\u043d\u0430\u0442\u0430 \u0436\u043b\u0435\u0437\u0430"},"content":{"rendered":"<p>[et_pb_section fb_built=&#8220;1&#8243; fullwidth=&#8220;on&#8220; _builder_version=&#8220;4.4.8&#8243; background_color=&#8220;rgba(0,0,0,0)&#8220; background_image=&#8220;https:\/\/www.intheranostics.com\/wp-content\/uploads\/2020\/06\/metastatik_prostat_kanseri.jpg&#8220; custom_padding=&#8220;100px||100px||false|false&#8220; locked=&#8220;off&#8220;][et_pb_fullwidth_header title=&#8220;\u0420\u0430\u043a \u043d\u0430 \u0449\u0438\u0442\u043e\u0432\u0438\u0434\u043d\u0430\u0442\u0430 \u0436\u043b\u0435\u0437\u0430 &#8220; text_orientation=&#8220;center&#8220; content_max_width_last_edited=&#8220;off|desktop&#8220; _builder_version=&#8220;4.4.8&#8243; title_font_size=&#8220;50px&#8220; content_font_size=&#8220;41px&#8220; subhead_font=&#8220;|700|||||||&#8220; subhead_font_size=&#8220;38px&#8220; subhead_line_height=&#8220;1.1em&#8220; background_enable_color=&#8220;off&#8220; background_enable_image=&#8220;off&#8220; custom_margin=&#8220;||||false|false&#8220; custom_padding=&#8220;||||false|false&#8220; animation_style=&#8220;slide&#8220; animation_direction=&#8220;bottom&#8220;][\/et_pb_fullwidth_header][\/et_pb_section][et_pb_section fb_built=&#8220;1&#8243; _builder_version=&#8220;4.4.8&#8243; custom_margin=&#8220;0px||0px||false|false&#8220; custom_padding=&#8220;0px|0px|0px|0px|false|false&#8220;][et_pb_row _builder_version=&#8220;4.4.8&#8243; custom_margin=&#8220;0px||||false|false&#8220; custom_padding=&#8220;0px|0px|0px|0px|false|false&#8220;][et_pb_column type=&#8220;4_4&#8243; _builder_version=&#8220;4.4.8&#8243;][et_pb_divider divider_weight=&#8220;0px&#8220; _builder_version=&#8220;4.4.8&#8243; use_background_color_gradient=&#8220;on&#8220; background_color_gradient_start=&#8220;#8dd2e1&#8243; background_color_gradient_end=&#8220;#23afca&#8220; background_color_gradient_direction=&#8220;90deg&#8220; width=&#8220;50%&#8220; module_alignment=&#8220;center&#8220; height=&#8220;10px&#8220;][\/et_pb_divider][\/et_pb_column][\/et_pb_row][\/et_pb_section][et_pb_section fb_built=&#8220;1&#8243; admin_label=&#8220;section&#8220; _builder_version=&#8220;3.22&#8243;][et_pb_row admin_label=&#8220;row&#8220; _builder_version=&#8220;4.4.8&#8243; background_size=&#8220;initial&#8220; background_position=&#8220;top_left&#8220; background_repeat=&#8220;repeat&#8220; custom_margin=&#8220;||||false|false&#8220; custom_padding=&#8220;0px|0px|0px|0px|false|false&#8220;][et_pb_column type=&#8220;4_4&#8243; _builder_version=&#8220;3.25&#8243; custom_padding=&#8220;|||&#8220; custom_padding__hover=&#8220;|||&#8220;][et_pb_text _builder_version=&#8220;4.4.8&#8243;]<\/p>\n<p>&nbsp;<\/p>\n<p>\u0420\u0430\u043a\u044a\u0442 \u043d\u0430 \u0449\u0438\u0442\u043e\u0432\u0438\u0434\u043d\u0430\u0442\u0430 \u0436\u043b\u0435\u0437\u0430 \u0435 \u0432\u0438\u0434 \u043e\u043d\u043a\u043e\u043b\u043e\u0433\u0438\u044f, \u043a\u043e\u044f\u0442\u043e \u043f\u0440\u043e\u0438\u0437\u0445\u043e\u0436\u0434\u0430 \u043e\u0442 \u043d\u0430\u043c\u0438\u0440\u0430\u0449\u0430\u0442\u0430 \u0441\u0435 \u0432 \u043f\u0440\u0435\u0434\u043d\u0430\u0442\u0430 \u0447\u0430\u0441\u0442 \u043d\u0430 \u0448\u0438\u044f\u0442\u0430 \u0442\u0438\u0440\u0435\u043e\u0438\u0434\u043d\u0430 \u0436\u043b\u0435\u0437\u0430. \u041d\u0430\u0439-\u0440\u0430\u0437\u043f\u0440\u043e\u0441\u0442\u0440\u0430\u043d\u0435\u043d\u0438\u044f\u0442 \u0441\u0438\u043c\u043f\u0442\u043e\u043c \u043d\u0430 \u0440\u0430\u043a\u0430 \u043d\u0430 \u0449\u0438\u0442\u043e\u0432\u0438\u0434\u043d\u0430\u0442\u0430 \u0436\u043b\u0435\u0437\u0430 \u0435 \u0431\u0435\u0437\u0431\u043e\u043b\u0435\u0437\u043d\u0435\u043d\u0430 \u043f\u043e\u0434\u0443\u0442\u0438\u043d\u0430 \u0438\u043b\u0438 \u0442\u0432\u044a\u0440\u0434\u043e\u0441\u0442, \u043e\u0431\u0440\u0430\u0437\u0443\u0432\u0430\u043b\u0430 \u0441\u0435 \u043f\u043e \u0448\u0438\u044f\u0442\u0430. \u0421\u0438\u043c\u043f\u0442\u043e\u043c\u0438 \u043a\u0430\u0442\u043e \u043d\u0435\u043e\u0431\u044f\u0441\u043d\u0438\u043c\u043e \u043f\u0440\u0435\u0441\u0438\u043f\u0432\u0430\u043d\u0435 \u043d\u0430 \u0433\u043b\u0430\u0441\u0430, \u0442\u0440\u0430\u0435\u0449\u043e \u043f\u043e\u0432\u0435\u0447\u0435 \u043e\u0442 \u043d\u044f\u043a\u043e\u043b\u043a\u043e \u0441\u0435\u0434\u043c\u0438\u0446\u0438, \u0437\u0430\u0442\u0440\u0443\u0434\u043d\u0435\u043d\u043e \u043f\u0440\u0435\u0433\u043b\u044a\u0449\u0430\u043d\u0435 \u0438\u043b\u0438 \u0431\u0435\u0437\u0431\u043e\u043b\u0435\u0437\u043d\u0435\u043d\u043e \u043f\u043e\u0434\u0443\u0432\u0430\u043d\u0435 \u043d\u0430 \u043b\u0438\u043c\u0444\u043d\u0438\u0442\u0435 \u0432\u044a\u0437\u043b\u0438 \u043f\u043e \u0448\u0438\u044f\u0442\u0430, \u043e\u0431\u0438\u043a\u043d\u043e\u0432\u0435\u043d\u043e \u0441\u0435 \u043f\u0440\u043e\u044f\u0432\u044f\u0432\u0430\u0442 \u0432 \u043f\u043e-\u043a\u044a\u0441\u043d\u0438\u0442\u0435 \u0441\u0442\u0430\u0434\u0438\u0438 \u043d\u0430 \u0431\u043e\u043b\u0435\u0441\u0442\u0442\u0430. \u041f\u0440\u0438 \u0441\u0440\u0430\u0432\u043d\u0435\u043d\u0438\u0435 \u0441 \u0434\u0440\u0443\u0433\u0438\u0442\u0435 \u0432\u0438\u0434\u043e\u0432\u0435 \u0440\u0430\u043a, \u043f\u0440\u043e\u0446\u0435\u0441\u044a\u0442 \u043d\u0430 \u0440\u0430\u0437\u0432\u0438\u0442\u0438\u0435 \u043d\u0430 \u0440\u0430\u043a\u0430 \u043d\u0430 \u0449\u0438\u0442\u043e\u0432\u0438\u0434\u043d\u0430\u0442\u0430 \u0436\u043b\u0435\u0437\u0430, \u0432 \u043e\u0441\u043d\u043e\u0432\u043d\u0438 \u043b\u0438\u043d\u0438\u0438, \u0435 \u043f\u043e-\u0434\u043e\u0431\u044a\u0440. \u041c\u043d\u043e\u0433\u043e \u043e\u0442 \u0431\u043e\u043b\u043d\u0438\u0442\u0435 \u0441 \u0440\u0430\u043a \u043d\u0430 \u0449\u0438\u0442\u043e\u0432\u0438\u0434\u043d\u0430\u0442\u0430 \u0436\u043b\u0435\u0437\u0430 \u043c\u043e\u0433\u0430\u0442 \u043b\u0435\u0441\u043d\u043e \u0434\u0430 \u0431\u044a\u0434\u0430\u0442 \u0438\u0437\u043b\u0435\u043a\u0443\u0432\u0430\u043d\u0438 \u0441 \u0445\u043e\u0440\u043c\u043e\u043d\u0430\u043b\u043d\u0430 \u0442\u0435\u0440\u0430\u043f\u0438\u044f, \u0442\u0435\u0440\u0430\u043f\u0438\u044f \u0441 \u0440\u0430\u0434\u0438\u043e\u0430\u043a\u0442\u0438\u0432\u0435\u043d \u0439\u043e\u0434-131.<\/p>\n<p>[\/et_pb_text][et_pb_accordion disabled_on=&#8220;on|on|on&#8220; _builder_version=&#8220;4.4.8&#8243; disabled=&#8220;on&#8220;][et_pb_accordion_item title=&#8220;TANI H\u0130ZMETLER\u0130 &#8211; I-131 T\u00dcM V\u00dcCUT TARAMA SINTIGRAFISI&#8220; open=&#8220;on&#8220; open_toggle_text_color=&#8220;#0ca7c5&#8243; _builder_version=&#8220;4.4.8&#8243; toggle_font=&#8220;|700|||||||&#8220; toggle_font_size=&#8220;18px&#8220;]<\/p>\n<p class=\"p1\"><span class=\"s1\"><b>Endikasyon<\/b><\/span><\/p>\n<p class=\"p2\"><span class=\"s1\"><b>Radyoaktif iyot t\u00fcm v\u00fccut sintigrafisi,<\/b> diferansiye tiroid kanserli hastalarda; <\/span><\/p>\n<p class=\"p2\"><span class=\"s1\">1) Tiroidektomi sonras\u0131, radyoaktif iyot ablasyonu \u00f6ncesinde lokorejyonel tutulumu de\u011ferlendirme ve \u00f6l\u00e7mede <\/span><\/p>\n<p class=\"p2\"><span class=\"s1\">2) Radyoaktif iyot ile ablasyon veya tedavi sonras\u0131 g\u00f6r\u00fcnt\u00fclemede <\/span><\/p>\n<p class=\"p3\"><span class=\"s1\">3) Tiroid kanseri n\u00fcks\u00fc orta veya y\u00fcksek riskli ve Tg \u00f6l\u00e7\u00fcmlerinin g\u00fcvenilir olmad\u0131\u011f\u0131 hastalar\u0131n takibinde endikedir. <\/span><\/p>\n<p class=\"p4\"><span class=\"s1\"><b>Radyoaktif \u0130yot T\u00fcm V\u00fccut Sintigrafisi Nedir, T\u00fcm\u00f6r Oda\u011f\u0131n\u0131 Nas\u0131l G\u00f6sterir?<\/b><\/span><\/p>\n<p class=\"p2\"><span class=\"s2\">Teranostik t\u0131p d\u00fcnyas\u0131nda yeni geli\u015fmekte olan bir aland\u0131r. T\u00fcm\u00f6re \u00f6zg\u00fcl bir ila\u00e7 ile g\u00f6r\u00fcnt\u00fcleme yaparak saptanan t\u00fcm\u00f6r ve metastazlar\u0131n\u0131n, nereye gidece\u011fi, ne kadar gidece\u011fi ve hastal\u0131kl\u0131 dokuyu etkileme g\u00fcc\u00fc \u00f6nceden bilinen yine \u00f6zg\u00fcl bir ila\u00e7 ile tedavi edilebildi\u011fi bir yakla\u015f\u0131md\u0131r. Bu yakla\u015f\u0131m, geleneksel t\u0131ptan ki\u015fiye \u00f6zg\u00fc \u00e7a\u011fda\u015f t\u0131p uygulamalar\u0131na ge\u00e7i\u015f yap\u0131lmas\u0131n\u0131 sa\u011flamaktad\u0131r.<\/span><\/p>\n<p class=\"p2\"><span class=\"s1\">Diferansiye tiroid kanserinde; bir yandan tan\u0131sal ama\u00e7la d\u00fc\u015f\u00fck doz radyoaktif iyot (I-131 <\/span><span class=\"s2\">veya I-123)<\/span><span class=\"s1\"> ile t\u00fcm\u00f6ral dokular\u0131n y\u00fcksek duyarl\u0131l\u0131k ve \u00f6zg\u00fcll\u00fckte g\u00f6r\u00fcnt\u00fclenebilmesi, di\u011fer yandan da y\u00fcksek doz radyoaktif iyot (I-131) ile bu t\u00fcm\u00f6ral dokular\u0131n \u00f6zg\u00fcl ve hedefe y\u00f6nelik tedavisi, teranostik uygulamalar i\u00e7in bilinen en eski \u00f6rnektir.<\/span><\/p>\n<p class=\"p2\"><span class=\"s1\">Tiroid dokusu, v\u00fccuttaki iyotun tamam\u0131n\u0131 kandan alarak kendi i\u00e7erisinde biriktirme konusunda e\u015fsiz bir yetene\u011fe sahiptir. Radyoaktif iyot da t\u0131pk\u0131 iyot gibi, sodyum-iyot simporter (NIS) membran proteinleri arac\u0131l\u0131\u011f\u0131yla tiroid bezine al\u0131narak, tiroid folik\u00fcler h\u00fccrelerinde depolanmaktad\u0131r. Papiller ve folik\u00fcler tip diferansiye tiroid kanserlerinde de, sa\u011fl\u0131kl\u0131 tiroid dokusuna g\u00f6re daha d\u00fc\u015f\u00fck d\u00fczeyde olmakla birlikte, NIS membran proteinleri bulunmaktad\u0131r. I-131 fiziksel yar\u0131 \u00f6mr\u00fc 8.1 g\u00fcn olan bir radyoizotop olup, g\u00f6r\u00fcnt\u00fclemede yararland\u0131\u011f\u0131m\u0131z 364 keV&#8217;luk temel gama radyasyonu ile tedavide kulland\u0131\u011f\u0131m\u0131z ortalama 0.192 MeV enerjiye ve dokuda ortalama 0.4 mm menzile sahip temel beta par\u00e7ac\u0131\u011f\u0131 yay\u0131mlamaktad\u0131r. <\/span><span class=\"s2\">G\u00f6r\u00fcnt\u00fclemede kulland\u0131\u011f\u0131m\u0131z di\u011fer bir radyoizotop olan I-123&#8217;\u00fcn fiziksel yar\u0131 \u00f6mr\u00fc ise yakla\u015f\u0131k 13 saat olup, g\u00f6r\u00fcnt\u00fclemede 159 keV&#8217;luk gama radyasyonundan faydalan\u0131lmaktad\u0131r.<\/span><\/p>\n<p class=\"p3\"><span class=\"s2\">Anaplastik (andiferansiye) ve med\u00fcller tiroid kanserleri ile lenfoma gibi tiroidin nadir g\u00f6r\u00fclen di\u011fer malign hastal\u0131klar\u0131 ise iyot tutulumu g\u00f6stermediklerinden, radyoaktif iyot bu hastalarda kullan\u0131lmamaktad\u0131r.<\/span><\/p>\n<p class=\"p1\"><span class=\"s1\"><b>Radyoaktif \u0130yot T\u00fcm V\u00fccut Sintigrafisi Kimlere Uygulan\u0131r?<\/b><\/span><\/p>\n<p class=\"p3\"><span class=\"s1\">Radyoaktif iyot t\u00fcm v\u00fccut sintigrafisi diferansiye tiroid kanserli hastalarda, tiroidektomi sonras\u0131, radyoaktif iyot ablasyonu \u00f6ncesinde lokorejyonel tutulumu de\u011ferlendirme ve \u00f6l\u00e7mede, radyoaktif iyot ile ablasyon veya tedavi sonras\u0131 g\u00f6r\u00fcnt\u00fclemede ve tiroid kanseri n\u00fcks\u00fc orta veya y\u00fcksek riskli ve Tg \u00f6l\u00e7\u00fcmlerinin g\u00fcvenilir olmad\u0131\u011f\u0131 hastalar\u0131n takibinde endikedir.\u00a0<\/span><\/p>\n<p class=\"p1\"><span class=\"s1\"><b>Radyoaktif \u0130yot T\u00fcm V\u00fccut Sintigrafisi G\u00fcvenli midir?<\/b><\/span><\/p>\n<p class=\"p5\"><span class=\"s1\">Radyoaktif iyot t\u00fcm v\u00fccut sintigrafisi, tedavi \u00f6ncesi d\u00fc\u015f\u00fck tan\u0131sal dozda radyoaktif iyot izotoplar\u0131 uygulanarak ger\u00e7ekle\u015ftirilen, g\u00fcvenli bir g\u00f6r\u00fcnt\u00fclemedir.<\/span><\/p>\n<p class=\"p3\"><span class=\"s2\">Radyoaktif iyot t\u00fcm v\u00fccut tarama sintigrafisi, hamilelerde uygulanamaz. Emziren annelerde ise emzirmenin sonland\u0131r\u0131lmas\u0131 gerekebilir. <span class=\"Apple-converted-space\">\u00a0 \u00a0<\/span><\/span><\/p>\n<p class=\"p1\"><span class=\"s1\"><b>Radyoaktif \u0130yot T\u00fcm V\u00fccut Sintigrafisi \u00d6ncesi Haz\u0131rl\u0131k <\/b><\/span><\/p>\n<p class=\"p2\"><span class=\"s1\">Radyoaktif iyot t\u00fcm v\u00fccut sintigrafisi \u00f6ncesinde; tiroidle ilgili t\u0131bbi hikaye, ameliyat\/patoloji raporlar\u0131 ve \u00f6nceki g\u00f6r\u00fcnt\u00fclemeleri, daha \u00f6nce uygulanm\u0131\u015f radyoaktif iyot tedavi dozlar\u0131 g\u00f6zden ge\u00e7irilir ve gerekti\u011finde a\u015fa\u011f\u0131daki kan testleri yapt\u0131r\u0131l\u0131r:<\/span><\/p>\n<ul>\n<li class=\"p2\"><span class=\"s1\">Tiroid fonksiyon testleri (\u00f6rn. TSH, fT3, fT4)<\/span><\/li>\n<li class=\"p2\"><span class=\"s1\">Tg, antiTg<\/span><\/li>\n<li class=\"p2\"><span class=\"s1\">beta-hCG, do\u011furganl\u0131k ya\u015f\u0131ndaki t\u00fcm kad\u0131n hastalarda, gebeli\u011fi d\u0131\u015flama amac\u0131yla yap\u0131lmal\u0131d\u0131r.<\/span><\/li>\n<\/ul>\n<p class=\"p2\"><span class=\"s1\">Tiroid hormonlar\u0131 (LT4, LT3), iyot i\u00e7eren ila\u00e7 ve yiyecekler, rezidiv tiroid dokusu ve tiroid d\u0131\u015f\u0131 metastatik lezyonlarda radyoaktif iyot tutulumunu engelleyece\u011finden tedavi \u00f6ncesi uygun hasta haz\u0131rl\u0131\u011f\u0131 yap\u0131lmal\u0131d\u0131r. <\/span><\/p>\n<p class=\"p3\"><span class=\"s1\">Radyoaktif iyot t\u00fcm v\u00fccut sintigrafisinin ba\u015far\u0131s\u0131nda kan TSH d\u00fczeyininin y\u00fcksek seviyede olmas\u0131 (TSH &gt;30 mIU\/L) \u00e7ok \u00f6nemlidir. TSH hem sa\u011fl\u0131kl\u0131 tiroid dokusunda, hem de tiroid kanseri h\u00fccrelerinde radyoaktif iyotun tutulumunu art\u0131rmaktad\u0131r. Radyoaktif iyot t\u00fcm v\u00fccut sintigrafisi \u00f6ncesi TSH seviyesini y\u00fckseltmenin birka\u00e7 yolu vard\u0131r:<\/span><\/p>\n<p class=\"p6\"><span class=\"s1\"><b>Tiroid Hormon Kullan\u0131m\u0131n\u0131n Kesilmesi<\/b><\/span><\/p>\n<p class=\"p3\"><span class=\"s1\">Radyoaktif iyot t\u00fcm v\u00fccut sintigrafisinden \u00f6nce tiroid hormonu kullan\u0131m\u0131n\u0131n kesilmesi planlan\u0131yorsa, LT4 hormon (Levotiron, Tefor, Euthyrox, Bitiron) kullan\u0131m\u0131 en az 4 hafta, LT3 hormon kullan\u0131m\u0131 (Tiromel) ise en az 2 hafta s\u00fcreyle kesilmelidir. LT4 kullanan hastalarda ilk iki haftal\u0131k d\u00f6nemde LT3 kullan\u0131labilir. Hedeflenen TSH &gt;30 mIU\/L&#8217;dir ve radyoaktif iyot uygulamas\u0131ndan \u00f6nce TSH \u00f6l\u00e7\u00fclmelidir.<\/span><\/p>\n<p class=\"p6\"><span class=\"s1\"><b>Rekombinant TSH (rhTSH) Kullan\u0131m\u0131<\/b><\/span><\/p>\n<p class=\"p3\"><span class=\"s1\">Tiroid hormon kullan\u0131m\u0131n\u0131n kesilmesinin alternatifi olan rhTSH (Thyrogen), 24 saat arayla iki doz \u015feklinde, kal\u00e7a kas\u0131na intram\u00fcsk\u00fcler enjeksiyonla uygulan\u0131r. Son rhTSH enjeksiyonundan 24 saat sonra da radyoaktif iyot oral yolla uygulan\u0131r. Rekombinant TSH uyguland\u0131\u011f\u0131 durumlarda tan\u0131sal serum tiroglobulin (Tg) \u00f6l\u00e7\u00fcm\u00fc, son rhTSH enjeksiyonundan 72 saat sonra yap\u0131lmal\u0131d\u0131r.<\/span><\/p>\n<p class=\"p6\"><span class=\"s1\"><b>D\u00fc\u015f\u00fck \u0130yotlu Diyet<\/b><\/span><\/p>\n<p class=\"p3\"><span class=\"s1\">Radyoaktif iyot t\u00fcm v\u00fccut sintigrafisinin 2 hafta \u00f6ncesinden ba\u015flanan d\u00fc\u015f\u00fck iyotlu diyet, i\u015flem \u00f6ncesi haz\u0131rl\u0131\u011f\u0131n \u00f6nemli bir par\u00e7as\u0131d\u0131r. Bu diyet, radyoaktif iyot t\u00fcm v\u00fccut sintigrafisinin ba\u015far\u0131s\u0131n\u0131 art\u0131rmaktad\u0131r. <\/span><\/p>\n<p class=\"p7\"><span class=\"s1\"><b>Radyoaktif \u0130yot Al\u0131m\u0131n\u0131 Engelleyen \u0130la\u00e7lar<\/b><\/span><\/p>\n<table class=\"t1\" cellspacing=\"0\" cellpadding=\"0\">\n<tbody>\n<tr>\n<td class=\"td1\" valign=\"top\">\n<p class=\"p8\"><span class=\"s1\"><b>\u0130la\u00e7lar<\/b><\/span><\/p>\n<\/td>\n<td class=\"td2\" valign=\"top\">\n<p class=\"p8\"><span class=\"s1\"><b>\u00d6nerilen kesilme s\u00fcresi<\/b><\/span><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td class=\"td3\" valign=\"top\">\n<p class=\"p8\"><span class=\"s1\">Tiyonamid ila\u00e7lar\u0131 (\u00f6rn. propiltiyourasil, metimazol, karbimazol) <\/span><\/p>\n<\/td>\n<td class=\"td4\" valign=\"top\">\n<p class=\"p8\"><span class=\"s1\">3 g\u00fcn<\/span><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td class=\"td1\" valign=\"top\">\n<p class=\"p8\"><span class=\"s1\">\u0130yot i\u00e7eren multivitaminler<\/span><\/p>\n<\/td>\n<td class=\"td2\" valign=\"top\">\n<p class=\"p8\"><span class=\"s1\">7-10 g\u00fcn<\/span><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td class=\"td1\" valign=\"top\">\n<p class=\"p8\"><span class=\"s1\">Do\u011fal\/sentetik tiroid hormonlar\u0131, triiyodotironin (LT3, Tiromel) i\u00e7in<\/span><\/p>\n<\/td>\n<td class=\"td2\" valign=\"top\">\n<p class=\"p8\"><span class=\"s1\">10-14 g\u00fcn<\/span><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td class=\"td5\" valign=\"top\">\n<p class=\"p8\"><span class=\"s1\">Do\u011fal\/sentetik tiroid hormonlar\u0131, tiroksin (LT4,<span class=\"Apple-converted-space\">\u00a0 <\/span>Levotiron, Tefor, Euthyrox, Bitiron) i\u00e7in<\/span><\/p>\n<\/td>\n<td class=\"td6\" valign=\"top\">\n<p class=\"p8\"><span class=\"s1\">3-4 hafta <\/span><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td class=\"td7\" valign=\"top\">\n<p class=\"p8\"><span class=\"s1\">Kelp, agar, karagenan, Lugol \u00e7\u00f6zeltisi<\/span><\/p>\n<\/td>\n<td class=\"td8\" valign=\"top\">\n<p class=\"p8\"><span class=\"s1\">2-3 hafta, iyot i\u00e7eri\u011fine ba\u011fl\u0131 olarak<\/span><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td class=\"td1\" valign=\"top\">\n<p class=\"p8\"><span class=\"s1\">Potasyum iyod\u00fcr\u00fcn sat\u00fcre sol\u00fcsyonu <\/span><\/p>\n<\/td>\n<td class=\"td2\" valign=\"top\">\n<p class=\"p8\"><span class=\"s1\">2-3 hafta<\/span><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td class=\"td1\" valign=\"top\">\n<p class=\"p8\"><span class=\"s1\">Topikal iyot (\u00f6rn. cerrahi deri haz\u0131rl\u0131\u011f\u0131)<\/span><\/p>\n<\/td>\n<td class=\"td2\" valign=\"top\">\n<p class=\"p8\"><span class=\"s1\">2-3 hafta<\/span><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td class=\"td3\" valign=\"top\">\n<p class=\"p8\"><span class=\"s1\">\u0130ntraven\u00f6z radyografik kontrast ajan, suda \u00e7\u00f6z\u00fcnen<\/span><\/p>\n<\/td>\n<td class=\"td4\" valign=\"top\">\n<p class=\"p8\"><span class=\"s1\">6-8 hafta<\/span><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td class=\"td1\" valign=\"top\">\n<p class=\"p8\"><span class=\"s1\">\u0130ntraven\u00f6z radyografik kontrast ajan, ya\u011fda \u00e7\u00f6z\u00fcnen<\/span><\/p>\n<\/td>\n<td class=\"td2\" valign=\"top\">\n<p class=\"p8\"><span class=\"s1\">1-6 ay<\/span><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td class=\"td1\" valign=\"top\">\n<p class=\"p8\"><span class=\"s1\">Amiodaron<\/span><\/p>\n<\/td>\n<td class=\"td2\" valign=\"top\">\n<p class=\"p8\"><span class=\"s1\">3-6 ay veya daha uzun<\/span><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td class=\"td3\" valign=\"top\">\n<p class=\"p8\"><span class=\"s2\">Sa\u00e7 boyas\u0131<\/span><\/p>\n<\/td>\n<td class=\"td4\" valign=\"top\">\n<p class=\"p8\"><span class=\"s2\">8 hafta<\/span><\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p class=\"p9\"><span class=\"s1\"><b><\/b><\/span><\/p>\n<p class=\"p7\"><span class=\"s1\"><b>Y\u00fcksek Miktarda \u0130yot \u0130\u00e7erdi\u011fi \u0130\u00e7in \u0130zin Verilmeyen<span class=\"Apple-converted-space\">\u00a0 <\/span>G\u0131dalar<\/b><\/span><\/p>\n<table class=\"t1\" cellspacing=\"0\" cellpadding=\"0\">\n<tbody>\n<tr>\n<td class=\"td9\" valign=\"top\">\n<p class=\"p10\"><span class=\"s1\"><b>Kaynak<\/b><\/span><\/p>\n<\/td>\n<td class=\"td10\" valign=\"top\">\n<p class=\"p10\"><span class=\"s1\"><b>\u00d6rnek\/a\u00e7\u0131klama<\/b><\/span><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td class=\"td11\" valign=\"top\">\n<p class=\"p8\"><span class=\"s1\">\u0130yotlu tuz<\/span><\/p>\n<\/td>\n<td class=\"td12\" valign=\"top\">\n<p class=\"p11\">\n<\/td>\n<\/tr>\n<tr>\n<td class=\"td9\" valign=\"top\">\n<p class=\"p8\"><span class=\"s1\">S\u00fct \u00fcr\u00fcnleri<\/span><\/p>\n<\/td>\n<td class=\"td10\" valign=\"top\">\n<p class=\"p8\"><span class=\"s1\">S\u00fct, yo\u011furt, peynir, dondurma<\/span><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td class=\"td9\" valign=\"top\">\n<p class=\"p8\"><span class=\"s1\">Yumurta sar\u0131s\u0131<\/span><\/p>\n<\/td>\n<td class=\"td10\" valign=\"top\">\n<p class=\"p8\"><span class=\"s1\">Yumurta ak\u0131 veya yumurta ikamesi <\/span><span class=\"s3\"><b>de\u011fil<\/b><\/span><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td class=\"td11\" valign=\"top\">\n<p class=\"p8\"><span class=\"s1\">Deniz \u00fcr\u00fcnleri<\/span><\/p>\n<\/td>\n<td class=\"td12\" valign=\"top\">\n<p class=\"p8\"><span class=\"s1\">Kabuklular ve bal\u0131klar, <\/span><span class=\"s3\"><b>ton bal\u0131\u011f\u0131 hari\u00e7<\/b><\/span><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td class=\"td9\" valign=\"top\">\n<p class=\"p8\"><span class=\"s1\">Hindi ve ci\u011fer<\/span><\/p>\n<\/td>\n<td class=\"td10\" valign=\"top\">\n<p class=\"p11\">\n<\/td>\n<\/tr>\n<tr>\n<td class=\"td9\" valign=\"top\">\n<p class=\"p8\"><span class=\"s1\">Yosun ve yosun \u00fcr\u00fcnleri<\/span><\/p>\n<\/td>\n<td class=\"td10\" valign=\"top\">\n<p class=\"p8\"><span class=\"s1\">Karagenan ve aljinat<\/span><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td class=\"td9\" valign=\"top\">\n<p class=\"p8\"><span class=\"s1\">S\u00fctl\u00fc \u00e7ikolata<\/span><\/p>\n<\/td>\n<td class=\"td10\" valign=\"top\">\n<p class=\"p11\">\n<\/td>\n<\/tr>\n<tr>\n<td class=\"td11\" valign=\"top\">\n<p class=\"p8\"><span class=\"s1\">\u0130yot i\u00e7eren multivitaminler<\/span><\/p>\n<\/td>\n<td class=\"td12\" valign=\"top\">\n<p class=\"p11\">\n<\/td>\n<\/tr>\n<tr>\n<td class=\"td13\" valign=\"top\">\n<p class=\"p8\"><span class=\"s1\">K\u0131rm\u0131z\u0131 g\u0131da boyas\u0131 (E127, eritrosin) i\u00e7eren \u00fcr\u00fcnler (\u00f6rn. ila\u00e7 boyas\u0131, gazl\u0131 i\u00e7ecek)<\/span><\/p>\n<\/td>\n<td class=\"td14\" valign=\"top\">\n<p class=\"p11\">\n<\/td>\n<\/tr>\n<tr>\n<td class=\"td13\" valign=\"top\">\n<p class=\"p8\"><span class=\"s1\">Tah\u0131llar<\/span><\/p>\n<\/td>\n<td class=\"td14\" valign=\"top\">\n<p class=\"p8\"><span class=\"s1\">Her \u00f6\u011f\u00fcnde sadece k\u00fc\u00e7\u00fck porsiyonlar \u015fekinde (\u00f6rn. bir taba\u011f\u0131n d\u00f6rtte biri) al\u0131nabilir.<\/span><\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p class=\"p12\"><span class=\"s1\"><\/span><\/p>\n<p class=\"p7\"><span class=\"s1\"><b>\u0130zin Verilen G\u0131dalar<\/b><\/span><\/p>\n<table class=\"t1\" cellspacing=\"0\" cellpadding=\"0\">\n<tbody>\n<tr>\n<td class=\"td15\" valign=\"top\">\n<p class=\"p8\"><span class=\"s1\">Taze meyve ve sebzeler<\/span><\/p>\n<p class=\"p8\"><span class=\"s1\">Tuzsuz f\u0131st\u0131k\/f\u0131nd\u0131k ve f\u0131nd\u0131k\/f\u0131st\u0131k ezmesi<\/span><\/p>\n<p class=\"p8\"><span class=\"s1\">Yumurta ak\u0131<\/span><\/p>\n<p class=\"p8\"><span class=\"s1\">Taze et<\/span><\/p>\n<p class=\"p8\"><span class=\"s1\">Tah\u0131l\/tah\u0131l \u00fcr\u00fcnleri, y\u00fcksek iyot i\u00e7ermeyen (g\u00fcnde 4 porsiyonla s\u0131n\u0131rl\u0131)<\/span><\/p>\n<p class=\"p8\"><span class=\"s1\">Makarna, y\u00fcksek iyot i\u00e7ermeyen<\/span><\/p>\n<p class=\"p8\"><span class=\"s1\">\u015eeker<\/span><\/p>\n<p class=\"p8\"><span class=\"s1\">J\u00f6le<\/span><\/p>\n<p class=\"p8\"><span class=\"s1\">Re\u00e7el<\/span><\/p>\n<p class=\"p8\"><span class=\"s1\">Bal<\/span><\/p>\n<p class=\"p8\"><span class=\"s1\">Karabiber<\/span><\/p>\n<p class=\"p8\"><span class=\"s1\">Taze veya kurutulmu\u015f ot ve baharatlar<\/span><\/p>\n<p class=\"p8\"><span class=\"s1\">T\u00fcm bitkisel ya\u011flar (soya ya\u011f\u0131 dahil)<\/span><\/p>\n<p class=\"p8\"><span class=\"s1\">Gazoz (K\u0131rm\u0131z\u0131 Boya (E127) i\u00e7ermeyen)<\/span><\/p>\n<p class=\"p8\"><span class=\"s1\">Kola, diyet kola<\/span><\/p>\n<p class=\"p8\"><span class=\"s1\">Kahve (instant \/haz\u0131r olmayan)<\/span><\/p>\n<p class=\"p8\"><span class=\"s1\">\u00c7ay (instant \/haz\u0131r olmayan)<\/span><\/p>\n<p class=\"p8\"><span class=\"s1\">Limonata<\/span><\/p>\n<p class=\"p8\"><span class=\"s1\">Meyve sular\u0131<\/span><\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p class=\"p13\"><span class=\"s1\"><\/span><\/p>\n<p class=\"p1\"><span class=\"s1\"><b>Radyoaktif \u0130yot T\u00fcm V\u00fccut Sintigrafisi Nas\u0131l Uygulan\u0131r?<\/b><\/span><\/p>\n<p class=\"p2\"><span class=\"s1\">Radyoaktif iyot uygulamas\u0131 \u00f6ncesinde 4-6 saat a\u011f\u0131zdan yiyecek veya su al\u0131m\u0131 tamamen durdurulmu\u015f olmal\u0131 ve radyoaktif iyot al\u0131nmas\u0131n\u0131 takiben yakla\u015f\u0131k 2 saat boyunca buna devam edilmelidir. <\/span><\/p>\n<p class=\"p2\"><span class=\"s1\">Bulant\u0131 \u015fikayeti olan hastalar i\u00e7in proflaktik oral antiemetik ila\u00e7 kullan\u0131lmas\u0131 d\u00fc\u015f\u00fcn\u00fcld\u00fc\u011f\u00fcnde, radyoaktif iyot verilmesi \u00f6ncesinde bu tedavinin uygulanmas\u0131 uygun olacakt\u0131r. <\/span><\/p>\n<p class=\"p2\">Radyoaktif iyot; s\u0131v\u0131, kaps\u00fcl (I-131 veya I-123, 37-185 MBq (1-5 mCi)) veya enjeksiyona haz\u0131r sol\u00fcsyon (I-123, 37-185 MBq (1-5 mCi)) formunda olup, N\u00fckleer T\u0131p Klini\u011finde oral veya damar yolu arac\u0131l\u0131\u011f\u0131yla, g\u00fcn\u00fcbirlik ayaktan uygulanmaktad\u0131r.<\/p>\n<p class=\"p5\"><span class=\"s1\">G\u00f6r\u00fcnt\u00fcler yine N\u00fckleer T\u0131p Klini\u011finde, radyoaktif iyot uygulamas\u0131ndan 48 ila 72 saat sonra elde edilmektedir.<\/span><\/p>\n<p class=\"p5\"><span class=\"s1\">B\u00f6brek fonksiyonlar\u0131 normal olan hastalarda, radyoaktif iyot al\u0131m\u0131n\u0131 takiben, 3 g\u00fcn boyunca, g\u00fcnl\u00fck 2,5-3 L su-s\u0131v\u0131 (s\u00fct hari\u00e7) al\u0131m\u0131 ve s\u0131k idrara \u00e7\u0131kma \u00f6nerilir. B\u00f6ylelikle mesane ve t\u00fck\u00fcr\u00fck bezinin radyasyon dozu minimum d\u00fczeyde tutulmaya \u00e7al\u0131\u015f\u0131l\u0131r. <\/span><\/p>\n<p class=\"p5\"><span class=\"s1\">G\u00fcnde en az bir kez d\u0131\u015fk\u0131lama, kal\u0131n barsak radyasyon dozunun minimum d\u00fczeye indirilmesi ve g\u00f6r\u00fcnt\u00fc kalitesinin art\u0131r\u0131lmas\u0131 i\u00e7in \u00f6nemlidir. Kab\u0131zl\u0131k durumunda hafif laksatifler kullan\u0131labilir. <\/span><\/p>\n<p class=\"p3\"><span class=\"s2\">I-131 radyoizotopu uygulanm\u0131\u015f hastalar\u0131n, yak\u0131nlar\u0131n\u0131 gereksiz radyasyondan korumak i\u00e7in baz\u0131 kurallara uymas\u0131 gerekmektedir. T\u00fcrkiye Atom Enerjisi Kurumu (TAEK) taraf\u0131ndan \u00f6nerilen bu k\u0131s\u0131tlamalar, uygulanan doza g\u00f6re de\u011fi\u015fmek ile birlikte \u015fu \u015feklidedir: <\/span><\/p>\n<p class=\"p14\"><span class=\"s1\"><b>TAEK Taraf\u0131ndan I-131 Uygulanm\u0131\u015f Hastalar \u0130\u00e7in \u00d6nerilen K\u0131s\u0131tlamalar<\/b><\/span><\/p>\n<p class=\"p13\">[\/et_pb_accordion_item][et_pb_accordion_item title=&#8220;TEDAV\u0130 H\u0130ZMETLER\u0130 &#8211; RADYOAKTIF \u0130YOT TEDAV\u0130S\u0130&#8220; open_toggle_text_color=&#8220;#0ca7c5&#8243; _builder_version=&#8220;4.4.8&#8243; toggle_font=&#8220;|700|||||||&#8220; toggle_font_size=&#8220;18px&#8220; open=&#8220;off&#8220;]<\/p>\n<p class=\"p1\"><span class=\"s1\"><b>Endikasyon<\/b><\/span><\/p>\n<p>&nbsp;<\/p>\n<p class=\"p3\"><span class=\"s1\"><b>Radyoaktif iyot<\/b> (I-131, radyoiyot veya atom tedavisi), diferansiye tiroid kanserli hastalarda; <\/span><\/p>\n<p>&nbsp;<\/p>\n<p class=\"p3\"><span class=\"s1\">1) Total veya totale yak\u0131n tiroidektomi sonras\u0131 rezid\u00fcel sa\u011fl\u0131kl\u0131 tiroid dokusunun ablasyonu <\/span><\/p>\n<p>&nbsp;<\/p>\n<p class=\"p3\"><span class=\"s1\">2) Subklinik mikroskobik hastal\u0131\u011f\u0131n adjuvan tedavisi <\/span><\/p>\n<p>&nbsp;<\/p>\n<p class=\"p4\"><span class=\"s1\">3) Makroskobik rezid\u00fcel\/n\u00fcks veya metastatik hastal\u0131\u011f\u0131n tedavisinde endikedir. <\/span><\/p>\n<p>&nbsp;<\/p>\n<p class=\"p5\"><span class=\"s1\"><b>Radyoaktif \u0130yot Tedavisi Nedir, Nas\u0131l Tedavi Eder?<\/b><\/span><\/p>\n<p>&nbsp;<\/p>\n<p class=\"p3\"><span class=\"s2\">Teranostik t\u0131p d\u00fcnyas\u0131nda yeni geli\u015fmekte olan bir aland\u0131r. T\u00fcm\u00f6re \u00f6zg\u00fcl bir ila\u00e7 ile g\u00f6r\u00fcnt\u00fcleme yaparak saptanan t\u00fcm\u00f6r ve metastazlar\u0131n\u0131n, nereye gidece\u011fi, ne kadar gidece\u011fi ve hastal\u0131kl\u0131 dokuyu etkileme g\u00fcc\u00fc \u00f6nceden bilinen yine \u00f6zg\u00fcl bir ila\u00e7 ile tedavi edilebildi\u011fi bir yakla\u015f\u0131md\u0131r. Bu yakla\u015f\u0131m, geleneksel t\u0131ptan ki\u015fiye \u00f6zg\u00fc \u00e7a\u011fda\u015f t\u0131p uygulamalar\u0131na ge\u00e7i\u015f yap\u0131lmas\u0131n\u0131 sa\u011flamaktad\u0131r.<\/span><\/p>\n<p>&nbsp;<\/p>\n<p class=\"p3\"><span class=\"s1\">Diferansiye tiroid kanserinde; bir yandan tan\u0131sal ama\u00e7la d\u00fc\u015f\u00fck doz radyoaktif iyot (I-131 <\/span><span class=\"s2\">veya I-123)<\/span><span class=\"s1\"> ile t\u00fcm\u00f6ral dokular\u0131n y\u00fcksek duyarl\u0131l\u0131k ve \u00f6zg\u00fcll\u00fckte g\u00f6r\u00fcnt\u00fclenebilmesi, di\u011fer yandan da y\u00fcksek doz radyoaktif iyot (I-131) ile bu t\u00fcm\u00f6ral dokular\u0131n \u00f6zg\u00fcl ve hedefe y\u00f6nelik tedavisi, teranostik uygulamalar i\u00e7in bilinen en eski \u00f6rnektir.<\/span><\/p>\n<p>&nbsp;<\/p>\n<p class=\"p3\"><span class=\"s1\">Radyoaktif iyot tedavisi, 1940&#8217;l\u0131 y\u0131llardan bu yana tiroidin benign ve malign hastal\u0131klar\u0131n\u0131n tedavisinde s\u0131kl\u0131kla tercih edilen, diferansiye tiroid kanserli hastalarda sa\u011f kal\u0131ma etkisi g\u00f6sterilmi\u015f standart bir uygulamad\u0131r.<\/span><\/p>\n<p>&nbsp;<\/p>\n<p class=\"p3\"><span class=\"s1\">Tiroid dokusu, v\u00fccuttaki iyotun tamam\u0131n\u0131 kandan alarak kendi i\u00e7erisinde biriktirme konusunda e\u015fsiz bir yetene\u011fe sahiptir. Radyoaktif iyot da t\u0131pk\u0131 iyot gibi, sodyum-iyot simporter (NIS) membran proteinleri arac\u0131l\u0131\u011f\u0131yla tiroid bezine al\u0131narak, tiroid folik\u00fcler h\u00fccrelerinde depolanmaktad\u0131r. Papiller ve folik\u00fcler tip diferansiye tiroid kanserlerinde de, sa\u011fl\u0131kl\u0131 tiroid dokusuna g\u00f6re daha d\u00fc\u015f\u00fck d\u00fczeyde olmakla birlikte, NIS membran proteinleri bulunmaktad\u0131r. I-131 fiziksel yar\u0131 \u00f6mr\u00fc 8.1 g\u00fcn olan bir radyon\u00fcklid olup, g\u00f6r\u00fcnt\u00fclemede yararland\u0131\u011f\u0131m\u0131z 364 keV&#8217;luk temel gama radyasyonu ile tedavide kulland\u0131\u011f\u0131m\u0131z ortalama 0.192 MeV enerjiye ve dokuda ortalama 0.4 mm menzile sahip temel beta par\u00e7ac\u0131\u011f\u0131 yay\u0131mlamaktad\u0131r. <\/span><\/p>\n<p>&nbsp;<\/p>\n<p class=\"p3\"><span class=\"s1\">Anaplastik (andiferansiye) ve med\u00fcller tiroid kanserleri ile lenfoma gibi tiroidin nadir g\u00f6r\u00fclen di\u011fer malign hastal\u0131klar\u0131 ise iyot tutulumu g\u00f6stermediklerinden, radyoaktif iyot tedavisi bu hastalarda kullan\u0131lmamaktad\u0131r.<\/span><\/p>\n<p>&nbsp;<\/p>\n<p class=\"p4\"><span class=\"s1\">\u00c7o\u011fu hasta i\u00e7in diferansiye tiroid kanserleri \u00e7ok iyi bir prognoza sahip olsa da, hastal\u0131\u011f\u0131n n\u00fcks veya sebat etme oran\u0131 %20-30&#8217;a kadar ula\u015fabilir ve n\u00fcks ilk tedaviden on y\u0131llar sonra bile ortaya \u00e7\u0131kabilir. Bu nedenle, kanserin tekrarlay\u0131p tekrarlanmad\u0131\u011f\u0131n\u0131 anlayabilmek i\u00e7in hastalar\u0131n d\u00fczenli takip edilmesi \u00f6nemlidir ve bu izleme hayat boyu devam edilmelidir.<\/span><\/p>\n<p>&nbsp;<\/p>\n<p class=\"p1\"><span class=\"s1\"><b>Radyoaktif \u0130yot Tedavisi Kimlere Uygulan\u0131r?<\/b><\/span><\/p>\n<p>&nbsp;<\/p>\n<p class=\"p4\"><span class=\"s1\">Radyoaktif iyot (I-131, radyoiyot veya atom tedavisi) diferansiye tiroid kanserli hastalarda, total veya totale yak\u0131n tiroidektomi sonras\u0131 rezid\u00fcel normal tiroid dokusunun ablasyonu, subklinik mikroskobik hastal\u0131\u011f\u0131n adjuvan tedavisi ve makroskobik rezid\u00fcel\/n\u00fcks veya metastatik hastal\u0131\u011f\u0131n tedavisinde endikedir.\u00a0<\/span><\/p>\n<p>&nbsp;<\/p>\n<p class=\"p6\"><span class=\"s1\"><b>Cerrahi Sonras\u0131 Radyoaktif \u0130yot Ablasyonu<\/b><\/span><\/p>\n<p>&nbsp;<\/p>\n<p class=\"p3\"><span class=\"s1\">Ameliyattan birka\u00e7 hafta sonra, cerrahi sonras\u0131 kalan tiroid kanseri h\u00fccrelerini veya normal tiroid dokusunu ortadan kald\u0131rma amac\u0131yla yap\u0131lan radyoaktif iyot uygulamas\u0131d\u0131r. Ablasyon ile ayr\u0131ca v\u00fccudun di\u011fer b\u00f6lgelerine yay\u0131lm\u0131\u015f tiroid kanseri h\u00fccrelerinin de ortadan kald\u0131r\u0131lmas\u0131 ama\u00e7lanmaktad\u0131r. Normal tiroid dokusu kal\u0131nt\u0131lar\u0131n\u0131n ortadan kald\u0131r\u0131lmas\u0131, olas\u0131 n\u00fcks hastal\u0131\u011f\u0131n izlemeni kolayla\u015ft\u0131racakt\u0131r. Bu katk\u0131ya ek olarak radyoaktif iyot ablasyonunun, kanserin boyun veya v\u00fccudun di\u011fer b\u00f6lgelerine yay\u0131ld\u0131\u011f\u0131 durumlarda sa\u011f kal\u0131m oranlar\u0131n\u0131 da iyile\u015ftirdi\u011fi g\u00f6sterilmi\u015ftir.<\/span><\/p>\n<p>&nbsp;<\/p>\n<p class=\"p7\"><span class=\"s1\"><b><\/b><\/span><\/p>\n<p>&nbsp;<\/p>\n<p class=\"p8\"><span class=\"s1\"><b>Amerikan Tiroid Birli\u011fi (ATA) risk s\u0131n\u0131flama sistemi ve AJCC\/TNM evreleme sistemine g\u00f6re cerrahi sonras\u0131 <\/b><\/span><span class=\"s2\"><b>g\u00fcncel<\/b><\/span><span class=\"s1\"><b> radyoaktif iyot (RA\u0130) ablasyon tedavisi \u00f6nerileri \u015fu \u015fekildedir:<\/b><\/span><\/p>\n<p>&nbsp;<\/p>\n<table class=\"t1\" cellspacing=\"0\" cellpadding=\"0\">\n<tbody>\n<tr>\n<td class=\"td1\" valign=\"top\">\n<p class=\"p9\"><span class=\"s1\">ATA risk eveleme<\/span><\/p>\n<\/td>\n<td class=\"td2\" valign=\"top\">\n<p class=\"p9\"><span class=\"s1\">Tan\u0131m<\/span><\/p>\n<\/td>\n<td class=\"td3\" valign=\"top\">\n<p class=\"p9\"><span class=\"s1\"><b> RA\u0130 ablasyon endikasyonu<\/b><\/span><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td class=\"td4\" valign=\"top\">\n<p class=\"p9\"><span class=\"s1\">ATA d\u00fc\u015f\u00fck risk<\/span><\/p>\n<p class=\"p9\"><span class=\"s1\">T1a<\/span><\/p>\n<p class=\"p9\"><span class=\"s1\">N0, Nx<\/span><\/p>\n<p class=\"p9\"><span class=\"s1\">M0, Mx<\/span><\/p>\n<\/td>\n<td class=\"td5\" valign=\"top\">\n<p class=\"p9\"><span class=\"s1\">T\u00fcm\u00f6r boyutu \u22641 cm (tek odak veya multifokal)<\/span><\/p>\n<p class=\"p10\">\n<\/td>\n<td class=\"td6\" valign=\"top\">\n<p class=\"p9\"><span class=\"s1\">Yok<\/span><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td class=\"td7\" valign=\"top\">\n<p class=\"p9\"><span class=\"s1\">ATA d\u00fc\u015f\u00fck risk<\/span><\/p>\n<p class=\"p9\"><span class=\"s1\">T1b, T2<\/span><\/p>\n<p class=\"p9\"><span class=\"s1\">N0, Nx<\/span><\/p>\n<p class=\"p9\"><span class=\"s1\">M0, Mx<\/span><\/p>\n<\/td>\n<td class=\"td8\" valign=\"top\">\n<p class=\"p9\"><span class=\"s1\">T\u00fcm\u00f6r boyutu &gt;1-4 cm <\/span><\/p>\n<\/td>\n<td class=\"td9\" valign=\"top\">\n<p class=\"p9\"><span class=\"s1\">D\u00fc\u015f\u00fcn\u00fclebilir. Rutin de\u011fil, agresif histolojisi veya vask\u00fcler invazyonu olan hastalar i\u00e7in d\u00fc\u015f\u00fcn\u00fclebilir.<\/span><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td class=\"td7\" valign=\"top\">\n<p class=\"p9\"><span class=\"s1\">ATA d\u00fc\u015f\u00fck ila orta risk<\/span><\/p>\n<p class=\"p9\"><span class=\"s1\">T3<\/span><\/p>\n<p class=\"p9\"><span class=\"s1\">N0, Nx<\/span><\/p>\n<p class=\"p9\"><span class=\"s1\">M0, Mx<\/span><\/p>\n<\/td>\n<td class=\"td8\" valign=\"top\">\n<p class=\"p9\"><span class=\"s1\">T\u00fcm\u00f6r boyutu &gt;4 cm <\/span><\/p>\n<\/td>\n<td class=\"td9\" valign=\"top\">\n<p class=\"p9\"><span class=\"s1\">Genellikle tercih edilir. <\/span><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td class=\"td4\" valign=\"top\">\n<p class=\"p9\"><span class=\"s1\">ATA d\u00fc\u015f\u00fck ila orta risk<\/span><\/p>\n<p class=\"p9\"><span class=\"s1\">T3<\/span><\/p>\n<p class=\"p9\"><span class=\"s1\">N0, Nx<\/span><\/p>\n<p class=\"p9\"><span class=\"s1\">M0, Mx<\/span><\/p>\n<\/td>\n<td class=\"td5\" valign=\"top\">\n<p class=\"p9\"><span class=\"s1\">Mikroskobik ekstratiroidal yay\u0131l\u0131m, herhangi t\u00fcm\u00f6r boyutunda<\/span><\/p>\n<\/td>\n<td class=\"td6\" valign=\"top\">\n<p class=\"p9\"><span class=\"s1\">Genellikle tercih edilir. <\/span><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td class=\"td7\" valign=\"top\">\n<p class=\"p9\"><span class=\"s1\">ATA d\u00fc\u015f\u00fck ila orta risk<\/span><\/p>\n<p class=\"p9\"><span class=\"s1\">T1-3<\/span><\/p>\n<p class=\"p9\"><span class=\"s1\">N1a<\/span><\/p>\n<p class=\"p9\"><span class=\"s1\">M0, Mx<\/span><\/p>\n<\/td>\n<td class=\"td8\" valign=\"top\">\n<p class=\"p9\"><span class=\"s1\">Santral servikal kompartman lenf nodu metastaz\u0131 <\/span><\/p>\n<p class=\"p11\"><span class=\"s1\"> <\/span><\/p>\n<\/td>\n<td class=\"td9\" valign=\"top\">\n<p class=\"p9\"><span class=\"s1\">Genellikle tercih edilir. <\/span><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td class=\"td7\" valign=\"top\">\n<p class=\"p9\"><span class=\"s1\">ATA d\u00fc\u015f\u00fck ila orta risk<\/span><\/p>\n<p class=\"p9\"><span class=\"s1\">T1-3<\/span><\/p>\n<p class=\"p9\"><span class=\"s1\">N1b<\/span><\/p>\n<p class=\"p9\"><span class=\"s1\">M0, Mx<\/span><\/p>\n<\/td>\n<td class=\"td8\" valign=\"top\">\n<p class=\"p9\"><span class=\"s1\">Lateral servikal kompartman veya mediastinal servikal lenf nodu metastaz\u0131<\/span><\/p>\n<\/td>\n<td class=\"td9\" valign=\"top\">\n<p class=\"p9\"><span class=\"s1\">Genellikle tercih edilir. <\/span><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td class=\"td7\" valign=\"top\">\n<p class=\"p9\"><span class=\"s1\">ATA y\u00fcksek risk<\/span><\/p>\n<p class=\"p9\"><span class=\"s1\">T4<\/span><\/p>\n<p class=\"p9\"><span class=\"s1\">Herhangi N<\/span><\/p>\n<p class=\"p9\"><span class=\"s1\">Herhangi M<\/span><\/p>\n<\/td>\n<td class=\"td8\" valign=\"top\">\n<p class=\"p9\"><span class=\"s1\">Geni\u015f ekstratiroidal yay\u0131l\u0131m, herhangi t\u00fcm\u00f6r boyutunda <\/span><\/p>\n<\/td>\n<td class=\"td9\" valign=\"top\">\n<p class=\"p9\"><span class=\"s1\">Evet<\/span><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td class=\"td4\" valign=\"top\">\n<p class=\"p9\"><span class=\"s1\">ATA y\u00fcksek risk<\/span><\/p>\n<p class=\"p9\"><span class=\"s1\">M1<\/span><\/p>\n<p class=\"p9\"><span class=\"s1\">Herhangi T<\/span><\/p>\n<p class=\"p9\"><span class=\"s1\">Herhangi N<\/span><\/p>\n<\/td>\n<td class=\"td5\" valign=\"top\">\n<p class=\"p9\"><span class=\"s1\">Uzak metastaz<\/span><\/p>\n<\/td>\n<td class=\"td6\" valign=\"top\">\n<p class=\"p9\"><span class=\"s1\">Evet <\/span><\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>&nbsp;<\/p>\n<p class=\"p7\"><span class=\"s1\"><\/span><\/p>\n<p>&nbsp;<\/p>\n<p class=\"p8\"><span class=\"s1\"><b>Amerikan Tiroid Birli\u011fi (ATA) risk s\u0131n\u0131flama sistemi:<\/b><\/span><\/p>\n<p>&nbsp;<\/p>\n<table class=\"t1\" cellspacing=\"0\" cellpadding=\"0\">\n<tbody>\n<tr>\n<td class=\"td10\" valign=\"top\">\n<p class=\"p9\"><span class=\"s1\"><b>D\u00fc\u015f\u00fck Risk<\/b> <\/span><\/p>\n<\/td>\n<td class=\"td11\" valign=\"top\">\n<p class=\"p9\"><span class=\"s1\">Lokal veya uzak metastaz yok. <\/span><\/p>\n<p class=\"p9\"><span class=\"s1\">Makroskopik t\u00fcm\u00f6r\u00fcn tamam\u0131 \u00e7\u0131kart\u0131lm\u0131\u015f.<\/span><\/p>\n<p class=\"p9\"><span class=\"s1\">\u00c7evre doku ve yap\u0131lara t\u00fcm\u00f6r invazyon yok.<\/span><\/p>\n<p class=\"p9\"><span class=\"s1\">Agresif t\u00fcm\u00f6r histolojisi yok (tall cell varyant, hobnail varyant, kolumnar h\u00fccreli karsinom gibi).<\/span><\/p>\n<p class=\"p9\"><span class=\"s1\">RA\u0130 verilmi\u015f ise tedavi sonras\u0131 taramada tiroid yata\u011f\u0131 d\u0131\u015f\u0131nda tutulum yok.<\/span><\/p>\n<p class=\"p9\"><span class=\"s1\">Vask\u00fcler invazyon yok.<\/span><\/p>\n<p class=\"p9\"><span class=\"s1\">Klinik olarak N0 veya \u22645 patolojik N1 mikrometastazlar ( en b\u00fcy\u00fck \u00e7ap\u0131 &lt;0.2cm)<\/span><\/p>\n<p class=\"p9\"><span class=\"s1\">\u0130ntratiroidal, enkaps\u00fcle follik\u00fcler varyant papiller tiroid kanseri<\/span><\/p>\n<p class=\"p9\"><span class=\"s1\">\u0130ntratiroidal, iyi diferansiye follik\u00fcler tiroid kanseri, kaps\u00fcl invazyonlu ve vask\u00fcler invazyon olmaks\u0131z\u0131n veya minimal vask\u00fcler invazyon ile (&lt;4 odak)<\/span><\/p>\n<p class=\"p9\"><span class=\"s1\">\u0130ntratiroidal papiller mikrokarsinom, tek veya multifokal, V600E BRAF mutasyonu (biliniyorsa)<\/span><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td class=\"td12\" valign=\"top\">\n<p class=\"p9\"><span class=\"s1\">Orta Risk<\/span><\/p>\n<\/td>\n<td class=\"td13\" valign=\"top\">\n<p class=\"p9\"><span class=\"s1\">Peritiroidal yumu\u015fak dokulara mikroskopik t\u00fcm\u00f6r invazyonu<\/span><\/p>\n<p class=\"p9\"><span class=\"s1\">Vask\u00fcler invazyon olan PTK<\/span><\/p>\n<p class=\"p9\"><span class=\"s1\">RA\u0130 tedavisi sonras\u0131 ilk t\u00fcm v\u00fccut iyot taramas\u0131nda tiroid yata\u011f\u0131 d\u0131\u015f\u0131nda boyunda tutulum<\/span><\/p>\n<p class=\"p9\"><span class=\"s1\">Agresif t\u00fcm\u00f6r histolojisi (tall cell varyant, hobnail varyant, kolumnar h\u00fccreli karsinom gibi)<\/span><\/p>\n<p class=\"p9\"><span class=\"s1\">Klinik olarak N1 veya en b\u00fcy\u00fck \u00e7ap\u0131 &lt;3cm olan &gt;5 patolojik N1<\/span><\/p>\n<p class=\"p9\"><span class=\"s1\">\u0130ntiroidal papiller tiroid kanseri, primer t\u00fcm\u00f6r 1-4cm, V600E BRAF mutasyonu (biliniyorsa)<\/span><\/p>\n<p class=\"p9\"><span class=\"s1\">Multifokal pailler mikrokarsinom, tiroid d\u0131\u015f\u0131na yay\u0131l\u0131m ve V600E BRAF mutasyonu (biliniyorsa)<\/span><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td class=\"td14\" valign=\"top\">\n<p class=\"p9\"><span class=\"s1\">Y\u00fcksek Risk<\/span><\/p>\n<\/td>\n<td class=\"td15\" valign=\"top\">\n<p class=\"p9\"><span class=\"s1\">Peritiroidal yumu\u015fak dokulara makroskopik t\u00fcm\u00f6r invazyonu (geni\u015f ekstratiroidal yay\u0131l\u0131m)<\/span><\/p>\n<p class=\"p9\"><span class=\"s1\">\u0130nkomplet t\u00fcm\u00f6r rezeksiyonu<\/span><\/p>\n<p class=\"p9\"><span class=\"s1\">Uzak metastaz <\/span><\/p>\n<p class=\"p9\"><span class=\"s1\">Uzak metastaz d\u00fc\u015f\u00fcnd\u00fcren, postoperatif serum Tg y\u00fcksekli\u011fi<\/span><\/p>\n<p class=\"p9\"><span class=\"s1\">Herhangi birinde en b\u00fcy\u00fck \u00e7ap\u0131 &gt;3cm olan patolojik N1 metastatik lenf nodu<\/span><\/p>\n<p class=\"p9\"><span class=\"s1\">Yayg\u0131n vask\u00fcler invazyon g\u00f6steren follik\u00fcler tiroid kanseri (&gt;4 odak)<\/span><\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>&nbsp;<\/p>\n<p class=\"p12\"><span class=\"s1\"><\/span><\/p>\n<p>&nbsp;<\/p>\n<p class=\"p6\"><span class=\"s1\"><b>N\u00fcks veya Rezid\u00fcel<span class=\"Apple-converted-space\">\u00a0 <\/span>Diferansiye Tiroid Kanserinin Radyoaktif \u0130yot ile Tedavisi<\/b><\/span><\/p>\n<p>&nbsp;<\/p>\n<p class=\"p4\"><span class=\"s1\">Kanser dokusu ameliyatla \u00e7\u0131kar\u0131labilecek gibiyse cerrahi genellikle ilk tercihtir. Radyoaktif iyot tedavisi, tek ba\u015f\u0131na veya ameliyatla birlikte kullan\u0131labilir. Kanser oda\u011f\u0131 radyoaktif iyot taramas\u0131nda kayda de\u011fer tutulum g\u00f6stermezken, MR veya 18F-FDG-PET taramas\u0131 gibi di\u011fer g\u00f6r\u00fcnt\u00fclemelerde saptan\u0131yorsa, radyoaktif iyota refrakter diferansiye tiroid kanseri varl\u0131\u011f\u0131ndan \u015f\u00fcphelenilmelidir. <\/span><\/p>\n<p>&nbsp;<\/p>\n<p class=\"p6\"><span class=\"s1\"><b>Radyoaktif \u0130yota Refrakter Diferansiye Tiroid Kanseri Tedavisi <\/b><\/span><\/p>\n<p>&nbsp;<\/p>\n<p class=\"p3\"><span class=\"s1\"><b><i>Tan\u0131m: <\/i><\/b><\/span><\/p>\n<p>&nbsp;<\/p>\n<ul>\n<li class=\"p3\"><span class=\"s1\">Malign\/metastatik doku hi\u00e7 radyoaktif iyot tutmaz (ilk tan\u0131sal t\u00fcm v\u00fccut sintigrafisinde tiroid yata\u011f\u0131 d\u0131\u015f\u0131nda tutulum olmamas\u0131). <\/span><\/li>\n<li class=\"p3\"><span class=\"s1\">\u00d6nceden radyoaktif iyota duyarl\u0131 hastal\u0131k kan\u0131t\u0131 mevcutken, t\u00fcm\u00f6r dokusunun radyoaktif iyot tutma yetene\u011fini kaybetmesi (kal\u0131c\u0131 iyot kontaminasyonu yoklu\u011funda).<\/span><\/li>\n<li class=\"p3\"><span class=\"s1\">Baz\u0131 lezyonlar radyoaktif iyot tutarken, di\u011ferlerinin tutmamas\u0131.<\/span><\/li>\n<li class=\"p3\"><span class=\"s1\">Metastatik hastal\u0131\u011f\u0131n anlaml\u0131 radyoaktif iyot tutulumuna ra\u011fmen progrese olmas\u0131.<\/span><\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p class=\"p4\"><span class=\"s1\">Radyoaktif iyota refrakter diferansiye tiroid kanseri olan hastalarda; termal ablasyon veya stereotaktik radyoterapi gibi lokal tedaviler ya da kinaz inhibit\u00f6rleri ile sistemik tedavi uygulanabilir. Sitotoksik kemoterapiler ise az \u00f6nce say\u0131lan di\u011fer y\u00f6ntemler ile kontrol edilemeyen hastalarda d\u00fc\u015f\u00fcn\u00fclebilir.<\/span><\/p>\n<p>&nbsp;<\/p>\n<p class=\"p1\"><span class=\"s1\"><b>Radyoaktif \u0130yot Tedavisi G\u00fcvenli Midir?<\/b><\/span><\/p>\n<p>&nbsp;<\/p>\n<p class=\"p3\"><span class=\"s1\">Radyoaktif iyot tedavisi hamilelerde uygulanamaz. Emziren annelerde ise emzirme sonland\u0131r\u0131lmal\u0131d\u0131r.\u00a0<\/span><\/p>\n<p>&nbsp;<\/p>\n<p class=\"p3\"><span class=\"s1\">Hemodiyaliz hastalar\u0131nda radyoaktif iyot tedavisi uygulanabilir.<\/span><\/p>\n<p>&nbsp;<\/p>\n<p class=\"p3\"><span class=\"s1\">\u0130yot alerjisi olan hastalarda radyoaktif iyot tedavisi uygulanabilir.<\/span><\/p>\n<p>&nbsp;<\/p>\n<p class=\"p3\"><span class=\"s1\">B\u00f6brek yetmezli\u011fi olan hastalarda, rhTSH dozu %50 veya daha fazla azalt\u0131labilir. <\/span><\/p>\n<p>&nbsp;<\/p>\n<p class=\"p3\"><span class=\"s1\">Kad\u0131n ve erkek hastalar\u0131n radyoaktif iyot tedavisinden sonra en az 6 ay boyunca partnerleri ile birlikte etkin kontrasepsiyon y\u00f6ntemlerini kullanmas\u0131 ve hamile kal\u0131nmamas\u0131 gerekmektedir.\u00a0<\/span><\/p>\n<p>&nbsp;<\/p>\n<p class=\"p2\"><span class=\"s1\"><\/span><\/p>\n<p>&nbsp;<\/p>\n<p class=\"p3\"><span class=\"s1\"><b>Radyoaktif \u0130yot Tedavisinin Potansiyel Yan Etkileri<\/b><\/span><\/p>\n<p>&nbsp;<\/p>\n<table class=\"t1\" cellspacing=\"0\" cellpadding=\"0\">\n<tbody>\n<tr>\n<td class=\"td16\" valign=\"top\">\n<p class=\"p9\"><span class=\"s1\"><b>Erken Yan Etkileri<\/b><\/span><\/p>\n<\/td>\n<td class=\"td17\" valign=\"top\">\n<p class=\"p9\"><span class=\"s1\"><b>\u00d6neri\/A\u00e7\u0131klama <\/b><\/span><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td class=\"td18\" valign=\"top\">\n<p class=\"p9\"><span class=\"s1\">Boyun b\u00f6lgesinde yanma hissi veya hassasiyet<\/span><\/p>\n<\/td>\n<td class=\"td19\" valign=\"top\">\n<p class=\"p9\"><span class=\"s1\">Ablasyonda; cerrahi sonras\u0131 rezid\u00fcel tiroid dokusu miktar\u0131 ile ili\u015fkilidir. Steroid veya NSA\u0130 ila\u00e7lar kullan\u0131labilir.<\/span><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td class=\"td20\" valign=\"top\">\n<p class=\"p9\"><span class=\"s1\">Oral mukozit ve beraberinde k\u00fc\u00e7\u00fck a\u011fr\u0131l\u0131 \u00fclserler<\/span><\/p>\n<\/td>\n<td class=\"td21\" valign=\"top\">\n<p class=\"p9\"><span class=\"s1\"> 4-7 g\u00fcn boyunca, uyan\u0131kken her 3-4 saatte bir yumu\u015fak di\u015f f\u0131r\u00e7as\u0131 ile t\u00fcm oral mukozan\u0131n hafif\u00e7e f\u0131r\u00e7alanmas\u0131yla bu durum s\u0131kl\u0131kla \u00f6nlenebilir. Buna, tedaviden sonraki ilk 4 g\u00fcn boyunca, geceleri her 3 saatte bir uygulama da eklenebilir.<\/span><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td class=\"td22\" valign=\"top\">\n<p class=\"p9\"><span class=\"s1\">Mide bulant\u0131s\u0131 (ve nadiren kusma)<\/span><\/p>\n<\/td>\n<td class=\"td23\" valign=\"top\">\n<p class=\"p9\"><span class=\"s1\">-5-HT3 antagonistleri (\u00f6rn. ondansetron, granisetron, her 8-12 saatte bir)<\/span><\/p>\n<p class=\"p9\"><span class=\"s1\">-Deksametazon ( her 8-12 saatte bir)<\/span><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td class=\"td24\" valign=\"top\">\n<p class=\"p9\"><span class=\"s1\">T\u00fck\u00fcr\u00fck bezlerinde \u015fi\u015fme ve hassasiyet<\/span><\/p>\n<\/td>\n<td class=\"td25\" valign=\"top\">\n<p class=\"p9\"><span class=\"s1\">-Y\u00fcksek d\u00fczeyde hidrasyon, yakla\u015f\u0131k 1 hafta boyunca g\u00fcnl\u00fck 2,5-3 L s\u0131v\u0131 (s\u00fct hari\u00e7) t\u00fcketilir.<\/span><\/p>\n<p class=\"p9\"><span class=\"s1\">-Sialagoglar (\u00f6rn. \u015fekersiz sak\u0131z\/\u015feker, pilokarpin ve askorbik asit) ile t\u00fck\u00fcr\u00fck ak\u0131\u015f h\u0131z\u0131n\u0131 art\u0131rma. RAI uygulamas\u0131ndan 2 saat sonra ba\u015flayarak 4 g\u00fcn boyunca t\u00fcm uyan\u0131k saatlerde ve tedaviden sonra 4 gece boyunca her 3 saatte bir.<\/span><\/p>\n<p class=\"p9\"><span class=\"s1\">-Deksametazon<span class=\"Apple-converted-space\">\u00a0 <\/span>(her 8-12 saatte bir)<\/span><\/p>\n<p class=\"p9\"><span class=\"s1\">-Amifostin<\/span><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td class=\"td16\" valign=\"top\">\n<p class=\"p9\"><span class=\"s1\">Tat duyusunda azalma ya da de\u011fi\u015fiklik <\/span><\/p>\n<\/td>\n<td class=\"td17\" valign=\"top\">\n<p class=\"p9\"><span class=\"s1\">Genellikle ge\u00e7ici<\/span><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td class=\"td16\" valign=\"top\">\n<p class=\"p9\"><span class=\"s1\">G\u00f6zya\u015f\u0131 \u00fcretiminde azalma<\/span><\/p>\n<\/td>\n<td class=\"td17\" valign=\"top\">\n<p class=\"p10\">\n<\/td>\n<\/tr>\n<tr>\n<td class=\"td26\" valign=\"top\">\n<p class=\"p9\"><span class=\"s1\">Kanda, akyuvar ve trombosit say\u0131s\u0131nda ge\u00e7ici azalma<\/span><\/p>\n<\/td>\n<td class=\"td27\" valign=\"top\">\n<p class=\"p9\"><span class=\"s1\">Y\u00fcksek doz RAI dozlar\u0131nda (150-200 mCi) g\u00f6r\u00fclebilir.<span class=\"Apple-converted-space\">\u00a0 <\/span>Bununla birlikte tedavi \u00f6ncesi normal kan say\u0131m\u0131 ve normal renal fonksiyonu bulunan hastalarda g\u00f6r\u00fclmesi beklenmemektedir. <\/span><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td class=\"td28\" valign=\"top\">\n<p class=\"p9\"><span class=\"s1\">rhTSH&#8217;nin neden oldu\u011fu; kemik (a\u011fr\u0131), beyin veya omurilik (n\u00f6rolojik semptomlar) veya akci\u011fer (dispne) metastazlar\u0131nda \u00f6dem<\/span><\/p>\n<\/td>\n<td class=\"td29\" valign=\"top\">\n<p class=\"p9\"><span class=\"s1\">Nadirdir.<\/span><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td class=\"td16\" valign=\"top\">\n<p class=\"p9\"><span class=\"s1\"><b>Ge\u00e7 Yan Etkileri<\/b><\/span><\/p>\n<\/td>\n<td class=\"td17\" valign=\"top\">\n<p class=\"p9\"><span class=\"s1\"><b>\u00d6neri\/A\u00e7\u0131klama<\/b><\/span><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td class=\"td30\" valign=\"top\">\n<p class=\"p9\"><span class=\"s1\">Erkeklerde fertilite<\/span><\/p>\n<\/td>\n<td class=\"td31\" valign=\"top\">\n<p class=\"p9\"><span class=\"s1\">Artm\u0131\u015f FSH d\u00fczeyi ve azalm\u0131\u015f spermatogeneze ba\u011fl\u0131 ge\u00e7ici infertilite, y\u00fcksek RAI tedavi dozlar\u0131nda g\u00f6r\u00fclebilir. Uygulanan tekrar tedaviler ile al\u0131nan k\u00fcm\u00fclatif dozun 200-300 mCi&#8217;yi a\u015ft\u0131\u011f\u0131 durumlarda ise kal\u0131c\u0131 infertilite geli\u015febilir. Y\u00fcksek doz RA\u0130 tedavisinden \u00f6nce sperm dondurma<span class=\"Apple-converted-space\">\u00a0 <\/span>d\u00fc\u015f\u00fcn\u00fclebilir. Testislerin ald\u0131\u011f\u0131 radyasyon dozu s\u0131k idrara \u00e7\u0131kma ile azalt\u0131labilir. <\/span><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td class=\"td18\" valign=\"top\">\n<p class=\"p9\"><span class=\"s1\">Kad\u0131nlarda fertilite<\/span><\/p>\n<\/td>\n<td class=\"td19\" valign=\"top\">\n<p class=\"p9\"><span class=\"s1\">RAI tedavisi ile kad\u0131n fertilitesinde bozulma veya d\u00fc\u015f\u00fck yapma riski art\u0131\u015f\u0131 g\u00f6zlenmemi\u015ftir. <\/span><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td class=\"td16\" valign=\"top\">\n<p class=\"p9\"><span class=\"s1\">A\u011f\u0131z kurulu\u011fu (kserostomi)<\/span><\/p>\n<\/td>\n<td class=\"td17\" valign=\"top\">\n<p class=\"p10\">\n<\/td>\n<\/tr>\n<tr>\n<td class=\"td16\" valign=\"top\">\n<p class=\"p10\">\n<\/td>\n<td class=\"td17\" valign=\"top\">\n<p class=\"p11\"><span class=\"s1\"> <\/span><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td class=\"td32\" valign=\"top\">\n<p class=\"p9\"><span class=\"s1\">Tat de\u011fi\u015fikli\u011fi (disguzi)<\/span><\/p>\n<\/td>\n<td class=\"td33\" valign=\"top\">\n<p class=\"p10\">\n<\/td>\n<\/tr>\n<tr>\n<td class=\"td16\" valign=\"top\">\n<p class=\"p13\"><span class=\"s1\">T\u00fck\u00fcr\u00fck bezi ta\u015f\u0131 (sialolitiazis)<\/span><span class=\"s3\"> <\/span><\/p>\n<\/td>\n<td class=\"td17\" valign=\"top\">\n<p class=\"p10\">\n<\/td>\n<\/tr>\n<tr>\n<td class=\"td16\" valign=\"top\">\n<p class=\"p9\"><span class=\"s1\">Di\u015f \u00e7\u00fcr\u00fcmesi<\/span><\/p>\n<\/td>\n<td class=\"td17\" valign=\"top\">\n<p class=\"p10\">\n<\/td>\n<\/tr>\n<tr>\n<td class=\"td16\" valign=\"top\">\n<p class=\"p9\"><span class=\"s1\">G\u00f6z kurulu\u011fu (kseroftalmi)<span class=\"Apple-converted-space\">\u00a0 <\/span>veya epifora<\/span><\/p>\n<\/td>\n<td class=\"td17\" valign=\"top\">\n<p class=\"p10\">\n<\/td>\n<\/tr>\n<tr>\n<td class=\"td34\" valign=\"top\">\n<p class=\"p9\"><span class=\"s1\">Sekonder malignite geli\u015fimi<\/span><\/p>\n<\/td>\n<td class=\"td35\" valign=\"top\">\n<p class=\"p9\"><span class=\"s1\">Y\u00fcksek doz RA\u0130 uygulamas\u0131 sonras\u0131 \u00e7ok nadir (&lt;%1) g\u00f6r\u00fclebilen bir durumdur. Bildirilen olgular genellikle birden \u00e7ok RA\u0130 tedavisi uygulanm\u0131\u015f hastalard\u0131r. Bu ihtimalin tiroid kanserinin getirece\u011fi risklerin yan\u0131nda ihmal edilebilir oldu\u011fu bilgisi unutulmamal\u0131d\u0131r.<\/span><\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>&nbsp;<\/p>\n<p class=\"p14\"><span class=\"s1\"><\/span><\/p>\n<p>&nbsp;<\/p>\n<p class=\"p1\"><span class=\"s1\"><b>Radyoaktif \u0130yot Tedavisi \u00d6ncesi Haz\u0131rl\u0131k <\/b><\/span><\/p>\n<p>&nbsp;<\/p>\n<p class=\"p3\"><span class=\"s1\">Radyoaktif iyot tedavisi \u00f6ncesinde; tiroidle ilgili t\u0131bbi hikaye, ameliyat\/patoloji raporlar\u0131 ve \u00f6nceki g\u00f6r\u00fcnt\u00fclemeleri, daha \u00f6nce uygulanm\u0131\u015f radyoaktif iyot tedavi dozlar\u0131 g\u00f6zden ge\u00e7irilerek fizik muayene yap\u0131l\u0131r ve gerekti\u011finde a\u015fa\u011f\u0131daki kan testleri yapt\u0131r\u0131l\u0131r:<\/span><\/p>\n<p>&nbsp;<\/p>\n<ul>\n<li class=\"p9\"><span class=\"s1\">Tiroid fonksiyon testleri (\u00f6rn. TSH, fT3, fT4)<\/span><\/li>\n<li class=\"p9\"><span class=\"s1\">Tg, antiTg<\/span><\/li>\n<li class=\"p9\"><span class=\"s1\">Serum kalsiyum, kalsitonin<\/span><\/li>\n<li class=\"p9\"><span class=\"s1\">Tam kan say\u0131m\u0131<\/span><\/li>\n<li class=\"p9\"><span class=\"s1\">Renal profil (\u00f6rn. BUN, kreatinin)<\/span><\/li>\n<li class=\"p9\"><span class=\"s1\">beta-hCG, do\u011furganl\u0131k ya\u015f\u0131ndaki t\u00fcm kad\u0131n hastalarda, gebeli\u011fi d\u0131\u015flama amac\u0131yla yap\u0131lmal\u0131d\u0131r.<\/span><\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p class=\"p3\"><span class=\"s1\">Tiroid hormonlar\u0131 (LT4, LT3), iyot i\u00e7eren ila\u00e7 ve yiyecekler, rezidiv tiroid dokusu ve tiroid d\u0131\u015f\u0131 metastatik lezyonlarda radyoaktif iyot tutulumunu engelleyece\u011finden tedavi \u00f6ncesi uygun hasta haz\u0131rl\u0131\u011f\u0131 yap\u0131lmal\u0131d\u0131r. <\/span><\/p>\n<p>&nbsp;<\/p>\n<p class=\"p4\"><span class=\"s1\">Radyoaktif iyot tedavisinin maksimum etkiyi g\u00f6sterebilmesinde kan TSH d\u00fczeyinin y\u00fcksek seviyede olmas\u0131 \u00e7ok \u00f6nemlidir. TSH hem sa\u011fl\u0131kl\u0131 tiroid dokusunda hem de tiroid kanseri h\u00fccrelerinde radyoaktif iyotun tutulumunu art\u0131rmaktad\u0131r. Radyoiyot tedavisi \u00f6ncesi bu hormon seviyesini y\u00fckseltmenin birka\u00e7 yolu vard\u0131r: <\/span><\/p>\n<p>&nbsp;<\/p>\n<p class=\"p6\"><span class=\"s1\"><b>Tiroid Hormon Kullan\u0131m\u0131n\u0131n Kesilmesi<\/b><\/span><\/p>\n<p>&nbsp;<\/p>\n<p class=\"p4\"><span class=\"s1\">Radyoaktif iyot ablasyon\/tedavisinden \u00f6nce tiroid hormonu kullan\u0131m\u0131n\u0131n kesilmesi planlan\u0131yorsa, LT4 hormon (Levotiron, Tefor, Euthyrox, Bitiron) kullan\u0131m\u0131 en az 4 hafta, LT3 hormon kullan\u0131m\u0131 (Tiromel) ise en az 2 hafta s\u00fcreyle kesilmelidir. LT4 kullanan hastalarda ilk iki haftal\u0131k d\u00f6nemde LT3 kullan\u0131labilir. Hedeflenen TSH &gt;30 mIU\/L&#8217;dir ve radyoaktif iyot uygulamas\u0131ndan \u00f6nce TSH \u00f6l\u00e7\u00fclmelidir. <\/span><\/p>\n<p>&nbsp;<\/p>\n<p class=\"p6\"><span class=\"s1\"><b>Rekombinant TSH (rhTSH) Kullan\u0131m\u0131<\/b><\/span><\/p>\n<p>&nbsp;<\/p>\n<p class=\"p3\"><span class=\"s1\">Tiroid hormon kullan\u0131m\u0131n\u0131n kesilmesinin alternatifi olan rhTSH (Thyrogen), 24 saat arayla iki doz \u015feklinde, kal\u00e7a kas\u0131na intram\u00fcsk\u00fcler enjeksiyonla uygulan\u0131r. Son rhTSH enjeksiyonundan 24 saat sonra da radyoaktif iyot, oral yolla uygulan\u0131r. Rekombinant TSH uyguland\u0131\u011f\u0131 durumlarda tan\u0131sal serum tiroglobulin (Tg) \u00f6l\u00e7\u00fcm\u00fc son rhTSH enjeksiyonundan 72 saat sonra yap\u0131lmal\u0131d\u0131r.\u00a0<\/span><\/p>\n<p>&nbsp;<\/p>\n<p class=\"p4\"><span class=\"s1\">B\u00f6brek yetmezli\u011fi olan hastalarda, rhTSH dozu %50 veya daha fazla azalt\u0131labilir.<\/span><\/p>\n<p>&nbsp;<\/p>\n<p class=\"p6\"><span class=\"s1\"><b>D\u00fc\u015f\u00fck \u0130yotlu Diyet<\/b><\/span><\/p>\n<p>&nbsp;<\/p>\n<p class=\"p4\"><span class=\"s1\">Radyoaktif iyot tedavisinin 2 hafta \u00f6ncesinden ba\u015flanan ve sonras\u0131nda 1-2 g\u00fcn s\u00fcren d\u00fc\u015f\u00fck iyotlu diyet, tedavi \u00f6ncesi haz\u0131rl\u0131\u011f\u0131n \u00f6nemli bir par\u00e7as\u0131d\u0131r. Bu diyet, radyoaktif iyot tedavisinin etkinli\u011fini art\u0131rmaktad\u0131r. <\/span><\/p>\n<p>&nbsp;<\/p>\n<p class=\"p15\"><span class=\"s1\"><b>Radyoaktif \u0130yot Al\u0131m\u0131n\u0131 Engelleyen \u0130la\u00e7lar<\/b><\/span><\/p>\n<p>&nbsp;<\/p>\n<table class=\"t1\" cellspacing=\"0\" cellpadding=\"0\">\n<tbody>\n<tr>\n<td class=\"td36\" valign=\"top\">\n<p class=\"p9\"><span class=\"s1\"><b>\u0130la\u00e7lar<\/b><\/span><\/p>\n<\/td>\n<td class=\"td37\" valign=\"top\">\n<p class=\"p9\"><span class=\"s1\"><b>\u00d6nerilen kesilme s\u00fcresi<\/b><\/span><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td class=\"td38\" valign=\"top\">\n<p class=\"p9\"><span class=\"s1\">Tiyonamid ila\u00e7lar\u0131 (\u00f6rn. propiltiyourasil, metimazol, karbimazol) <\/span><\/p>\n<\/td>\n<td class=\"td39\" valign=\"top\">\n<p class=\"p9\"><span class=\"s1\">3 g\u00fcn<\/span><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td class=\"td36\" valign=\"top\">\n<p class=\"p9\"><span class=\"s1\">\u0130yot i\u00e7eren multivitaminler<\/span><\/p>\n<\/td>\n<td class=\"td37\" valign=\"top\">\n<p class=\"p9\"><span class=\"s1\">7-10 g\u00fcn<\/span><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td class=\"td36\" valign=\"top\">\n<p class=\"p9\"><span class=\"s1\">Do\u011fal\/sentetik tiroid hormonlar\u0131, triiyodotironin (LT3, Tiromel) i\u00e7in<\/span><\/p>\n<\/td>\n<td class=\"td37\" valign=\"top\">\n<p class=\"p9\"><span class=\"s1\">10-14 g\u00fcn, <\/span><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td class=\"td40\" valign=\"top\">\n<p class=\"p9\"><span class=\"s1\">Do\u011fal\/sentetik tiroid hormonlar\u0131, tiroksin (LT4,<span class=\"Apple-converted-space\">\u00a0 <\/span>Levotiron, Tefor, Euthyrox, Bitiron) i\u00e7in<\/span><\/p>\n<\/td>\n<td class=\"td41\" valign=\"top\">\n<p class=\"p9\"><span class=\"s1\">3-4 hafta <\/span><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td class=\"td42\" valign=\"top\">\n<p class=\"p9\"><span class=\"s1\">Kelp, agar, karagenan, Lugol \u00e7\u00f6zeltisi<\/span><\/p>\n<\/td>\n<td class=\"td43\" valign=\"top\">\n<p class=\"p9\"><span class=\"s1\">2-3 hafta, iyot i\u00e7eri\u011fine ba\u011fl\u0131 olarak<\/span><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td class=\"td36\" valign=\"top\">\n<p class=\"p9\"><span class=\"s1\">Potasyum iyod\u00fcr\u00fcn sat\u00fcre sol\u00fcsyonu <\/span><\/p>\n<\/td>\n<td class=\"td37\" valign=\"top\">\n<p class=\"p9\"><span class=\"s1\">2-3 hafta<\/span><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td class=\"td36\" valign=\"top\">\n<p class=\"p9\"><span class=\"s1\">Topikal iyot (\u00f6rn. cerrahi deri haz\u0131rl\u0131\u011f\u0131)<\/span><\/p>\n<\/td>\n<td class=\"td37\" valign=\"top\">\n<p class=\"p9\"><span class=\"s1\">2-3 hafta<\/span><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td class=\"td38\" valign=\"top\">\n<p class=\"p9\"><span class=\"s1\">\u0130ntraven\u00f6z radyografik kontrast ajan, suda \u00e7\u00f6z\u00fcnen<\/span><\/p>\n<\/td>\n<td class=\"td39\" valign=\"top\">\n<p class=\"p9\"><span class=\"s1\">6-8 hafta<\/span><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td class=\"td36\" valign=\"top\">\n<p class=\"p9\"><span class=\"s1\">\u0130ntraven\u00f6z radyografik kontrast ajan, ya\u011fda \u00e7\u00f6z\u00fcnen<\/span><\/p>\n<\/td>\n<td class=\"td37\" valign=\"top\">\n<p class=\"p9\"><span class=\"s1\">1-6 ay<\/span><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td class=\"td36\" valign=\"top\">\n<p class=\"p9\"><span class=\"s1\">Amiodaron<\/span><\/p>\n<\/td>\n<td class=\"td37\" valign=\"top\">\n<p class=\"p9\"><span class=\"s1\">3-6 ay veya daha uzun<\/span><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td class=\"td38\" valign=\"top\">\n<p class=\"p9\"><span class=\"s2\">Sa\u00e7 boyas\u0131<\/span><\/p>\n<\/td>\n<td class=\"td39\" valign=\"top\">\n<p class=\"p9\"><span class=\"s2\">8 hafta<\/span><\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>&nbsp;<\/p>\n<p class=\"p16\"><span class=\"s1\"><b><\/b><\/span><\/p>\n<p>&nbsp;<\/p>\n<p class=\"p15\"><span class=\"s1\"><b>Y\u00fcksek Miktarda \u0130yot \u0130\u00e7erdi\u011fi \u0130\u00e7in \u0130zin Verilmeyen<span class=\"Apple-converted-space\">\u00a0 <\/span>G\u0131dalar<\/b><\/span><\/p>\n<p>&nbsp;<\/p>\n<table class=\"t1\" cellspacing=\"0\" cellpadding=\"0\">\n<tbody>\n<tr>\n<td class=\"td44\" valign=\"top\">\n<p class=\"p8\"><span class=\"s1\"><b>Kaynak<\/b><\/span><\/p>\n<\/td>\n<td class=\"td45\" valign=\"top\">\n<p class=\"p8\"><span class=\"s1\"><b>\u00d6rnek\/a\u00e7\u0131klama<\/b><\/span><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td class=\"td46\" valign=\"top\">\n<p class=\"p9\"><span class=\"s1\">\u0130yotlu tuz<\/span><\/p>\n<\/td>\n<td class=\"td47\" valign=\"top\">\n<p class=\"p10\">\n<\/td>\n<\/tr>\n<tr>\n<td class=\"td44\" valign=\"top\">\n<p class=\"p9\"><span class=\"s1\">S\u00fct \u00fcr\u00fcnleri<\/span><\/p>\n<\/td>\n<td class=\"td45\" valign=\"top\">\n<p class=\"p9\"><span class=\"s1\">S\u00fct, yo\u011furt, peynir, dondurma<\/span><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td class=\"td44\" valign=\"top\">\n<p class=\"p9\"><span class=\"s1\">Yumurta sar\u0131s\u0131<\/span><\/p>\n<\/td>\n<td class=\"td45\" valign=\"top\">\n<p class=\"p9\"><span class=\"s1\">Yumurta ak\u0131 veya yumurta ikamesi <\/span><span class=\"s4\"><b>de\u011fil<\/b><\/span><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td class=\"td46\" valign=\"top\">\n<p class=\"p9\"><span class=\"s1\">Deniz \u00fcr\u00fcnleri<\/span><\/p>\n<\/td>\n<td class=\"td47\" valign=\"top\">\n<p class=\"p9\"><span class=\"s1\">Kabuklular ve bal\u0131klar, <\/span><span class=\"s4\"><b>ton bal\u0131\u011f\u0131 hari\u00e7<\/b><\/span><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td class=\"td44\" valign=\"top\">\n<p class=\"p9\"><span class=\"s1\">Hindi ve ci\u011fer<\/span><\/p>\n<\/td>\n<td class=\"td45\" valign=\"top\">\n<p class=\"p10\">\n<\/td>\n<\/tr>\n<tr>\n<td class=\"td44\" valign=\"top\">\n<p class=\"p9\"><span class=\"s1\">Yosun ve yosun \u00fcr\u00fcnleri<\/span><\/p>\n<\/td>\n<td class=\"td45\" valign=\"top\">\n<p class=\"p9\"><span class=\"s1\">Karagenan ve aljinat<\/span><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td class=\"td44\" valign=\"top\">\n<p class=\"p9\"><span class=\"s1\">S\u00fctl\u00fc \u00e7ikolata<\/span><\/p>\n<\/td>\n<td class=\"td45\" valign=\"top\">\n<p class=\"p10\">\n<\/td>\n<\/tr>\n<tr>\n<td class=\"td46\" valign=\"top\">\n<p class=\"p9\"><span class=\"s1\">\u0130yot i\u00e7eren multivitaminler<\/span><\/p>\n<\/td>\n<td class=\"td47\" valign=\"top\">\n<p class=\"p10\">\n<\/td>\n<\/tr>\n<tr>\n<td class=\"td48\" valign=\"top\">\n<p class=\"p9\"><span class=\"s1\">K\u0131rm\u0131z\u0131 g\u0131da boyas\u0131 (E127, eritrosin) i\u00e7eren \u00fcr\u00fcnler (\u00f6rn. ila\u00e7 boyas\u0131, gazl\u0131 i\u00e7ecek)<\/span><\/p>\n<\/td>\n<td class=\"td49\" valign=\"top\">\n<p class=\"p10\">\n<\/td>\n<\/tr>\n<tr>\n<td class=\"td48\" valign=\"top\">\n<p class=\"p9\"><span class=\"s1\">Tah\u0131llar<\/span><\/p>\n<\/td>\n<td class=\"td49\" valign=\"top\">\n<p class=\"p9\"><span class=\"s1\">Her \u00f6\u011f\u00fcnde sadece k\u00fc\u00e7\u00fck porsiyonlar \u015fekinde (\u00f6rn. bir taba\u011f\u0131n d\u00f6rtte biri) al\u0131nabilir.<\/span><\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>&nbsp;<\/p>\n<p class=\"p12\"><span class=\"s1\"><\/span><\/p>\n<p>&nbsp;<\/p>\n<p class=\"p15\"><span class=\"s1\"><b>\u0130zin Verilen G\u0131dalar<\/b><\/span><\/p>\n<p>&nbsp;<\/p>\n<table class=\"t1\" cellspacing=\"0\" cellpadding=\"0\">\n<tbody>\n<tr>\n<td class=\"td50\" valign=\"top\">\n<p class=\"p9\"><span class=\"s1\">Taze meyve ve sebzeler<\/span><\/p>\n<p class=\"p9\"><span class=\"s1\">Tuzsuz f\u0131st\u0131k\/f\u0131nd\u0131k ve f\u0131nd\u0131k\/f\u0131st\u0131k ezmesi<\/span><\/p>\n<p class=\"p9\"><span class=\"s1\">Yumurta ak\u0131<\/span><\/p>\n<p class=\"p9\"><span class=\"s1\">Taze et<\/span><\/p>\n<p class=\"p9\"><span class=\"s1\">Tah\u0131l\/tah\u0131l \u00fcr\u00fcnleri, y\u00fcksek iyot i\u00e7ermeyen (g\u00fcnde 4 porsiyonla s\u0131n\u0131rl\u0131)<\/span><\/p>\n<p class=\"p9\"><span class=\"s1\">Makarna, y\u00fcksek iyot i\u00e7ermeyen<\/span><\/p>\n<p class=\"p9\"><span class=\"s1\">\u015eeker<\/span><\/p>\n<p class=\"p9\"><span class=\"s1\">J\u00f6le<\/span><\/p>\n<p class=\"p9\"><span class=\"s1\">Re\u00e7el<\/span><\/p>\n<p class=\"p9\"><span class=\"s1\">Bal<\/span><\/p>\n<p class=\"p9\"><span class=\"s1\">Karabiber<\/span><\/p>\n<p class=\"p9\"><span class=\"s1\">Taze veya kurutulmu\u015f ot ve baharatlar<\/span><\/p>\n<p class=\"p9\"><span class=\"s1\">T\u00fcm bitkisel ya\u011flar (soya ya\u011f\u0131 dahil)<\/span><\/p>\n<p class=\"p9\"><span class=\"s1\">Gazoz (K\u0131rm\u0131z\u0131 Boya (E127) i\u00e7ermeyen)<\/span><\/p>\n<p class=\"p9\"><span class=\"s1\">Kola, diyet kola<\/span><\/p>\n<p class=\"p9\"><span class=\"s1\">Kahve (instant \/haz\u0131r olmayan)<\/span><\/p>\n<p class=\"p9\"><span class=\"s1\">\u00c7ay (instant \/haz\u0131r olmayan)<\/span><\/p>\n<p class=\"p9\"><span class=\"s1\">Limonata<\/span><\/p>\n<p class=\"p9\"><span class=\"s1\">Meyve sular\u0131<\/span><\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>&nbsp;<\/p>\n<p class=\"p12\"><span class=\"s1\"><\/span><\/p>\n<p>&nbsp;<\/p>\n<p class=\"p1\"><span class=\"s1\"><b>Radyoaktif \u0130yot Tedavisi Nas\u0131l Uygulan\u0131r?<\/b><\/span><\/p>\n<p>&nbsp;<\/p>\n<p class=\"p3\"><span class=\"s1\">Radyoaktif iyot uygulamas\u0131 \u00f6ncesinde 4-6 saat a\u011f\u0131zdan yiyecek veya su al\u0131m\u0131 tamamen durdurulmu\u015f olmal\u0131 ve radyoaktif iyot al\u0131nmas\u0131n\u0131 takiben yakla\u015f\u0131k 2 saat boyunca buna devam edilmelidir. <\/span><\/p>\n<p>&nbsp;<\/p>\n<p class=\"p3\"><span class=\"s1\">Proflaktik oral antiemetik d\u00fc\u015f\u00fcn\u00fcld\u00fc\u011f\u00fcnde, tedavi \u00f6ncesinde uygulanmas\u0131 uygun olacakt\u0131r. <\/span><\/p>\n<p>&nbsp;<\/p>\n<p class=\"p3\"><span class=\"s1\">Tedavi i\u00e7in plananlanan radyoaktif iyot dozu, s\u0131v\u0131 veya kaps\u00fcl formunda olup \u00f6zel tedavi odas\u0131nda oral yoldan uygulan\u0131r. <\/span><\/p>\n<p>&nbsp;<\/p>\n<p class=\"p3\"><span class=\"s1\">Hastanede kal\u0131s\u0327 s\u00fcresi; uygulanan doza ve hasta \u00f6l\u00e7\u00fcmlerine g\u00f6re de\u011fi\u015fmekle birlikte genellikle 3 g\u00fcn ile 1 hafta aras\u0131nda deg\u0306is\u0327ebilmektedir. <\/span><\/p>\n<p>&nbsp;<\/p>\n<p class=\"p3\"><span class=\"s1\">Tedaviden yakla\u015f\u0131k 3-7 g\u00fcn sonra hastalara evreleme amac\u0131yla, t\u00fcm v\u00fccut radyoaktif iyot sintigrafisi\/SPECT\/BT yap\u0131lmaktad\u0131r.<\/span><\/p>\n<p>&nbsp;<\/p>\n<p class=\"p4\"><span class=\"s1\">Uygulanacak dozun se\u00e7iminde, kanser n\u00fcks\u00fc veya mortalite riski ile ili\u015fkili de\u011ferlendirme esas al\u0131nmaktad\u0131r.<\/span><\/p>\n<p>&nbsp;<\/p>\n<p class=\"p17\"><span class=\"s1\"><b>Farkl\u0131 Klinik Durumlar \u0130\u00e7in \u00d6nerilen Radyoaktif \u0130yot Dozlar\u0131<\/b><\/span><\/p>\n<p>&nbsp;<\/p>\n<table class=\"t1\" cellspacing=\"0\" cellpadding=\"0\">\n<tbody>\n<tr>\n<td class=\"td51\" valign=\"top\">\n<p class=\"p9\"><span class=\"s1\"><b>Endikasyon <\/b><\/span><\/p>\n<\/td>\n<td class=\"td52\" valign=\"top\" colspan=\"2\">\n<p class=\"p9\"><span class=\"s1\"><b>\u00d6nerilen RA\u0130 dozu<\/b><\/span><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td class=\"td53\" valign=\"top\">\n<p class=\"p9\"><span class=\"s1\">Cerrahi sonras\u0131 tiroid yata\u011f\u0131ndaki remnant dokunun ablasyonu<\/span><\/p>\n<\/td>\n<td class=\"td54\" valign=\"top\">\n<p class=\"p9\"><span class=\"s1\">1.11 \u2013 3.7 MBq<\/span><\/p>\n<\/td>\n<td class=\"td55\" valign=\"top\">\n<p class=\"p9\"><span class=\"s1\">30-100 mCi<\/span><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td class=\"td51\" valign=\"top\">\n<p class=\"p9\"><span class=\"s1\">Servikal\/mediastinal lenf nodu metastazlar\u0131n\u0131n tedavisi<\/span><\/p>\n<\/td>\n<td class=\"td56\" valign=\"top\">\n<p class=\"p9\"><span class=\"s1\">5.55-7.4 MBq<\/span><\/p>\n<\/td>\n<td class=\"td57\" valign=\"top\">\n<p class=\"p9\"><span class=\"s1\">150-200 mCi <\/span><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td class=\"td58\" valign=\"top\">\n<p class=\"p9\"><span class=\"s1\">\u0130leri lokal\/b\u00f6lgesel hastal\u0131\u011f\u0131 olan hastalar \u00f6nce cerrahi, sonras\u0131nda RA\u0130 ile veya klinik olarak endike ise eksternal radyasyonu ile tedavi edilebilir.<\/span><\/p>\n<\/td>\n<td class=\"td59\" valign=\"top\">\n<p class=\"p10\">\n<\/td>\n<td class=\"td60\" valign=\"top\">\n<p class=\"p10\">\n<\/td>\n<\/tr>\n<tr>\n<td class=\"td53\" valign=\"top\">\n<p class=\"p9\"><span class=\"s1\">Uzak metastaz tedavisi<\/span><\/p>\n<\/td>\n<td class=\"td54\" valign=\"top\">\n<p class=\"p9\"><span class=\"s1\">\u2265 7.4 MBq<\/span><\/p>\n<\/td>\n<td class=\"td55\" valign=\"top\">\n<p class=\"p9\"><span class=\"s1\">\u2265 200 mCi<\/span><\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>&nbsp;<\/p>\n<p class=\"p2\"><span class=\"s1\"><\/span><\/p>\n<p>&nbsp;<\/p>\n<p class=\"p3\"><span class=\"s1\">B\u00f6brek fonksiyonlar\u0131 normal olan hastalarda, radyoaktif iyot al\u0131m\u0131n\u0131 takiben 1 hafta boyunca, g\u00fcnl\u00fck 2,5-3 L s\u0131v\u0131 (s\u00fct hari\u00e7) al\u0131m\u0131 ve s\u0131k idrara \u00e7\u0131kma \u00f6nerilir. B\u00f6ylelikle mesane ve t\u00fck\u00fcr\u00fck bezinin ald\u0131\u011f\u0131 radyasyon dozunu minimum d\u00fczeyde tutulmaya \u00e7al\u0131\u015f\u0131l\u0131r. <\/span><\/p>\n<p>&nbsp;<\/p>\n<p class=\"p3\"><span class=\"s1\">G\u00fcnde en az bir kez d\u0131\u015fk\u0131lama, kal\u0131n ba\u011f\u0131rsaklar\u0131n alm\u0131\u015f oldu\u011fu radyasyon dozunu minimum d\u00fczeye indirilmesi i\u00e7in \u00f6nemlidir. Kab\u0131zl\u0131k durumunda hafif laksatifler kullan\u0131labilir. <\/span><\/p>\n<p>&nbsp;<\/p>\n<p class=\"p3\"><span class=\"s1\">Yat\u0131r\u0131larak tedavi endikasyonu hastaya verilen doza ba\u011fl\u0131d\u0131r ve yasal d\u00fczenlemelerle belirlenmi\u015ftir. Burada ama\u00e7, hasta yak\u0131nlar\u0131n\u0131 ve toplumu radyasyondan korumakt\u0131r. <\/span><\/p>\n<p>&nbsp;<\/p>\n<p class=\"p3\"><span class=\"s1\">Radyoaktif iyot tedavisinin ayaktan veya yatarak uyguland\u0131\u011f\u0131 hastalarda, taburcu edilebilmeleri i\u00e7in belli \u00f6nlemlerin al\u0131nmas\u0131 gerekir. Bu tedavinin uyguland\u0131\u011f\u0131 hastalar, v\u00fccutlar\u0131nda kalan aktivite d\u00fczeyi T\u00fcrkiye Atom Enerjisi Kurumu (TAEK) mevzuat\u0131nda belirlenen taburcu edilme limit deg\u0306erlerinin alt\u0131na d\u00fcs\u0327t\u00fckten sonra taburcu edilebilirler. <\/span><\/p>\n<p>&nbsp;<\/p>\n<p class=\"p4\"><span class=\"s1\">Kad\u0131n ve erkek hastalar\u0131n radyoaktif iyot tedavisinden sonra en az 6 ay boyunca partnerleri ile birlikte etkin kontrasepsiyon y\u00f6ntemlerini kullanmas\u0131 ve hamile kal\u0131nmamas\u0131 gerekmektedir. <\/span><\/p>\n<p>&nbsp;<\/p>\n<p class=\"p18\"><span class=\"s2\"><b>TAEK Taraf\u0131ndan RA\u0130 (I-131) Uygulanm\u0131\u015f Hastalar \u0130\u00e7in \u00d6nerilen K\u0131s\u0131tlamalar<\/b><\/span><\/p>\n<p>&nbsp;<\/p>\n<p class=\"p12\">\n<p>[\/et_pb_accordion_item][\/et_pb_accordion][et_pb_code _builder_version=&#8220;4.4.8&#8243;][\/et_pb_code][et_pb_button button_url=&#8220;@ET-DC@eyJkeW5hbWljIjp0cnVlLCJjb250ZW50IjoicG9zdF9saW5rX3VybF9wYWdlIiwic2V0dGluZ3MiOnsicG9zdF9pZCI6IjE2MDEifX0=@&#8220; 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