新疆昌吉回族自治州结节性甲状腺肿术后血清促甲状腺素水平与复发关系的研究

Relationship between postoperative serum thyroid-stimulating hormone concentration and recurrence of nodular goiter in Changji Hui autonomous prefecture of Xinjiang

目的:研究新疆昌吉州结节性甲状腺肿术后血清促甲状腺素(thyroid-stimulating hormone,TSH)水平与复发的关系及影响因素,进一步探讨结节性甲状腺肿术后抑制血清TSH值的合适水平。方法:回顾性分析新疆昌吉回族自治州人民医院781例结节性甲状腺肿手术患者,按性别、年龄、最大结节径、结节数目及施行手术方式的不同分别统计不同术后血清TSH值范围内的患者例数,统计分析术后复发率的差异。结果:结节性甲状腺肿术后复发组血清TSH水平为(3.21±1.34)mIU/L,明显高于未复发组患者的(1.09±0.63)mIU/L,(t=20.344 9,P=0.000 0)。结节性甲状腺肿患者手术后随着血清中TSH水平的降低,复发率逐渐降低,但当TSH水平降低至1.0 mIU/L以下,其复发率并不再继续下降。术后血清TSH水平在4.5 mIU/L以下,甲状腺切除的范围越大,其复发的机会就越低。当TSH水平超过4.5 mIU/L,仅甲状腺次全切除组复发率小于甲状腺部分切除术组及腺叶切除+峡部切除组,后两组复发率差异无统计学意义(χ2=0.000,P=1.000)。结论:在切除足够的甲状腺后,抑制TSH至1.0 mIU/L以下水平,能够最大限度地防止术后复发,同时又可以尽可能降低因应用左旋甲状腺素带来的不良作用。

Objective ：To study of relationship between postoperative serum thyroid-stimulating hormone （TSH） concentration and re- currence of nodular goiter in Changji Hui autonomous prefecture of Xinjiang and its influencing factors and to further investigate the appropriate level of serum TSH suppression after nodular goiter operation. Methods：Retrospective analysis was made on 781 cases of nodular goiter in People＇ s Hospital of Changji Hui Autonomous Prefecture. Number of cases within different serum TSH values was counted based on different genders, ages, maximum nodule diameters, nodule numbers and operation modes. Differences in recurrence rates were statistically analyzed. Results： Concentration of serum TSH was significantly higher in those with nodular goiter recurrence than in those without recurrence（3.21_＋l.34） mIU/L vs. （1.09 ＋ 0.63） mIU/L（t=20.344 9,P=0.000 0）. With the reduction of postop- erative serum TSH level, recurrence rate in patients with nodular goiter was gradually reduced. But when serum TSH level was reduced to less than 1.0 mIU/L, recurrence rate was no longer declined. When postoperative serum TSH level was lower than 4.5 mIU/L, the larger the thyroidectomy ranges, the lower the recurrence rates. When serum TSH concentration was higher than 4.5 mIU/L, recurrence rate was lower in subtotal thyroidectomy group than in partial thyroidectomy group and lobectomy＋isthmusectomies group, with no sig- nificant difference in recurrence rate between the latter two groups （X^2=0.000, P=1.000）. Conclusions：Excising enough thyroid and suppressing TSH to less than 1.0 mIU/L can maximally prevent the recurrence and minimize the adverse effects due to the application of levothyroxine.