分化型甲状腺癌患者术后应用甲状腺素及停药对心血管的影响

The effects of Levothyronine theropy and Thyroxine withdrawal on cardiovascular function with differentiated thyroid carcinoma

目的探讨分化型甲状腺癌患者术后左旋甲状腺素的应用和撤退心血管的影响。方法用化学发光法测定60例分化型甲状腺癌患者应用左旋甲状腺素形成TSH抑制(访视1)、停药后1周(访视2)、3周(访视3)及60例甲状腺功能正常的对照组血清FT3、FT4及TSH水平并查心脏彩超,动态血压监测。结果 DTC患者访视1、2时,TSH低于正常;访视3时,TSH明显高于正常。访视1、3和访视2相比均有夜间血压升高,"非杓型者"的比例明显增加。DTC患者访视3心率及心输出量明显降低,舒张功能明显减退。结论 DTC患者术后应用甲状腺素或停药对心血管均有不良影响。

Objective To evaluate the effects of levothyroxine therapy and thyroxine withdrawal on cardiovascular function in patients with differentiated thyroid carcinoma（DTC）.Methods Sixty patients with DTC on levothyroxine therapy and 60 healthy controls were studied.We evaluated cardiac function before and 1 and 3 weeks after thyroxine withdrawal according to hormone levels,echocardiography and ambulatory blood pressure monitoring.Results When compared with visit 2,the percentage of non-dippers were increased during hypothyroidism and hyperthyroidism.Left ventricular mass and ejection fraction did not change during thyroxine withdrawal.Conclusion The levothyroxine therapy and thyroxine withdrawal of DTC have undesirable impact on cardiovascular system.