辐射对鼻咽癌放疗病人甲状腺功能的早期影响

Early effect of thyroid function after radiotherapy for patients with nasopharygeal carcinoma

目的探讨辐射对鼻咽癌病人甲状腺功能的早期影响,观察其临床症状、检测指标的诊断价值,为放射性甲状腺损伤的诊断提供依据。方法从2006年2月-2008年2月,42例鼻咽癌放疗照射野包括颈部甲状腺的病人为第一组,40例照射野包括下丘脑-垂体但不包括甲状腺的病人为第二组,分别在放疗前、放疗开始后1个月、2个月、3个月、6个月检测促甲状腺激素(TSH)、游离型T3(FT3)、游离型T4(FT4),观察变化情况及临床症状。结果第一组病人在放疗前、放疗开始后1个月、2个月、3个月、6个月,中位TSH呈升高趋势,放疗开始后3个月、6个月高于放疗前,有统计学意义(P<0.05);各检测点的中位FT3、FT4呈降低趋势,放疗开始后3个月、6个月低于放疗前,有统计学意义(P<0.05);第二组病人各项指标未见趋势性变化和统计学意义;两组比较在放疗开始后3个月、6个月,第一组病人TSH高于第二组,FT3、FT4低于第二组,有统计学意义(P<0.05);两组病人均未见特异性甲状腺功能异常的临床症状。结论辐射早期即可导致甲状腺功能减退,且无特异性临床症状,很难单独根据临床症状做出诊断,因此甲状腺功能的定期检测是十分必要的。

Objective To inquire early effect of thyroid function after radiotherapy for patients with nasopharyngeal carcinoma, clinical characteristic,evaluation index,and provide the basis for the diagnosis.Methods The group 1 included the eligible patients of nasopharyngeal caner, the group 2 included the patients whose radiation poaal comprised hypothalamic-pituitary axis without thyroid gland. The levels of free triiodothyronine （FT3 ）, free thyroxine （FT4）, and thyroid stimulating hormone（TSH） of the blood serum were measured before radiotherapy（baseline values）, 1,2,3,6 months after the beginning of radiotherapy. The changes of various index and related clinical characteristic were observed. Results From February 2006 to February 2008,42 patients who belong to group 1 and 40 patients who belong to group 2 had been studied in our department. In group 1, mean senan levels of TSH had a significant increase at before radiotherapy （ baseline values）, 1,2,3,6 months after the beginning of radiotherapy （ baseline values vs. 3 months： P 〈 0.05, baseline values vs.6 months： P 〈 0.05） ;mean serum levels of FT3 and FT4 had a significant decrease at various times（baseline values vs.3 months： P 〈 0.05, baseline values vs. 6 months： P 〈 0.05） ; In group 2, there was no significant difference on thyroid function; at the 3 and 6 months after the beginning ofradiothempy, TSH levels of group 1 was higher than those of group 2, FT3 and Fr4 levels of group 1 was lower than those of group 2. Special clinical characteristic of hypothyroidism had not been observed on two groups. Conclusion Radiation on thyroid can induce hypothyroidism on early phase, there was no special clinical characteristic on diagnosis,it is essential to check thyroid hormone levels at regular intervals after radiotherapy.