目的 探讨DTC颈部转移与肺/骨转移131I治疗与全身显像的临床特点。方法 选择115例DTC患者，依据病理及影像学检查分为颈部淋巴结转移组103例和肺/骨远处转移组12例。在相关管理指标、131I清甲治疗、131I -WBS、年龄、病理类型、131I疗效评价等多方面进行比较。结果 DTC颈部转移中危组的TG、RAIU水平明显低于远处转移高危组，两组差异有统计学意义（P＜0.01）；TSH水平明显高于高危组，两组差异有统计学意义（P＜0.01）；TGAb水平两组差异无统计学意义（P＞0.05）。通过131I治疗与治疗后全身显像，115例甲状腺癌发现肺转移9例、骨转移3例，甲状腺癌远处转移率为10.43%；在12例高危组患者中，年龄≤45岁组发生肺转移7/75例、年龄＞45岁组发生肺转移2/40例，两组比较差异无统计学意义（χ2=0.679，P＞0.05）；年龄≤45岁组发生骨转移0例，年龄＞45岁组发生骨转移3/40例，两组差异有统计学意义（P =0.042，P＜0.05）；甲状腺乳头状癌远处转移10/95例，甲状腺滤泡状癌远处转移2/20例，两组差异无统计学意义（χ2=0.005，P＞0.05）；颈部转移组甲状腺残留去除率为65.05%，远处转移组颈部甲状腺残留去除率为58.33%，两组去除率差异无统计学意义（χ2=0.211，P＞0.05）。症状改善在甲状腺癌肺转移经131I治疗后100%近期有效，在骨转移131I治疗后66.7%近期有效，两组差异无统计学意义（P=0.333，P＞0.05）。结论 分化型甲状腺癌颈部淋巴结转移或肺/骨转移患者的诸多管理随访指标包括131I全身显像有着重要的临床应用价值，积极用131I清甲治疗、清灶治疗均有较好的疗效，对治愈甲状腺癌或缓解病情有重要的临床指导意义。

Objective To investigate clinical characteristics of 131I therapy and whole body imaging of Differential Thyroid Cancer (DTC) with neck, lung and bone metastases. Methods 115 cases of DTC patients according to pathology and imaging results were divided into two groups: cervical lymph node metastasis group (103 cases), lung and bone metastasis group (12 cases). Some management indicators such as 131I remove thyroid treatment, 131I-WBS, age, histological type, 131I treatment efficacy were evaluated. Results The TG and RAIU levels in DTC with neck metastasis (middle-risk group) were significantly lower than that of with distant metastasis (high-risk group). The TSH levels in high-risk group were significantly higher than that of others (P <0.01). There was no significantly difference in TGAb level between two groups (P> 0.05). 131I whole-body imaging showed that nine cases had lung metastases, 3 cases had bone metastases. The thyroid cancer metastasis rate was 10.43%. Conclusion 131I whole body imaging has important clinical value in the management of differentiated thyroid carcinoma patients with cervical lymph node metastases, lung and bone metastasis.