甲状腺腺叶切除术后血清甲状腺激素水平的变化

A study on serum thyroid hormone level alterations after hemithyroidectomy

目的 探讨甲状腺良性结节行单侧腺叶切除术后血清T3 、T4、TSH的变化及其替代治疗。方法 前瞻性随机选择单侧甲状腺良性结节患者4 8例,以4 5岁为界分为两组,行单侧腺叶切除术,术后不服用甲状腺素片。观察术后第5天、1个月、3个月、6个月、12个月血清TT3 、TT4、FT3 、FT4、TSH的变化。结果 甲状腺腺叶切除术后血清TT3 、TT4无显著变化;4 5岁以上组FT3 、FT4分别在术后第5天和1个月呈一过性降低(F =7. 85 3,F =4. 2 4 7,P <0 . 0 1) ,4 5岁以下组FT3 、FT4的变化不明显;TSH则在术后第5天至12个月均高于术前(F =6. 134,P <0 . 0 1) ,1个月后呈下降趋势。结论 甲状腺良性结节行单侧腺叶切除术后甲状腺功能在一定时间内可以自我调节代偿,但年龄大或较年轻代偿能力差者,需进行适当的替代治疗。

Objective To investigate serum T_3? T_4? TSH alterations after hemithyroidectomy in patients suffering from thyroid benign nodules.Methods Forty-eight patients were divided into two groups by age of 45.All patients were treated with hemithyroidectomy and without substitutional therapy after operation.The levels of serum TT_3? TT_4? FT_3? FT_4? TSH were assessed on day 5, first month, 3rd month, 6th month and one year after operation and compared with pre-operative levels.Results The change of serum T_3? T_4 was not significant; while the levels of serum FT_3? FT_4 in patients over 45 years decreased on day 5 post-op and on the first month ( F=7.853, F=4.247, P <0.01), while in patients below 45 years the change was not significant; s-TSH increased significantly from the fifth day to one year ( F=6.134, P <0.01).Conclusion Thyroid function could be adjusted and recuperated by itself after hemithyroidectomy in patients with benign thyroid nodules .But the recuperative ability is so poor in older patients that substitutional therapy is justified.