促甲状腺素抑制治疗对老年患者情绪的影响

Effects of suppressive therapy of thyroid-stimulating hormone on emotion status in elderly patients

目的 探讨分化型甲状腺癌患者（DTC）术后促甲状腺激素（TSH）水平与老年患者情绪的关系. 方法 测定患者血清游离三碘甲腺原氨酸（FT3）、游离甲状腺素（FT4）及促甲状腺激素（TSH）水平.入选患者165例,其中行DTC根治术老年患者74例,行结节性甲状腺肿双侧甲状腺次全切除术者（无抑制组）43例,甲状腺功能检查结果正常（健康对照组）48例;行DTC根治术老年患者再根据测定血清TSH水平分为完全抑制组（33例）和部分抑制组（41例）;并使用汉密尔顿焦虑量表（HAMA）及汉密尔顿抑郁量表（HAMD）进行评定. 结果 完全抑制组HAMA评分与无抑制组和健康对照组比较,差异均有统计学意义（P＜0.01）,与部分抑制组比较差异有统计学意义（P＜0.05）;各组HAMD评分间比较差异均无统计学意义.完全抑制组TSH水平、游离甲状腺素（FT4）水平与HAMA总分具有相关性（P＜0.05）. 结论 TSH完全抑制组老年患者的焦虑症状比其他各组更为严重;完全抑制组焦虑症状与甲状腺功能异常存在相关性,适当调整DTC术后TSH抑制水平有可能改善老年患者的焦虑症状.

Objective To analyze the effects of suppressive therapy of thyroid-stimulating hormone（TSH） on emotion status in elderly patients undergoing resection of differentiated thyroid cancer （DTC）.Methods Serum levels of free T3 （FT3）,free T4 （FT4） and TSH were measured in elderly patients.165 patients were enrolled,in whom 74 cases with DTC underwent complete resection and TSH suppressive therapy [completely （CSG,n=33） and partially （PSG,n=41）],43 cases with nodular goiter without TSH suppressive therapy （WSG） underwent bilateral subtotal thyroidectomy and 48 cases had normal thyroid function （normal control group,NCG）.Hamilton Anxiety Rating Scale （HAMA） and Hamilton Depression Rating Scale （HAMD） were used to evaluate patients＆#39; emotion status.Results There were significant differences in scores of HAMA between CSG and other three groups [PSG （P〈0.05）,WSG （P〈0.01） and NCG （P〈0.01）].However,there was no significant difference in HAMD scores among the four groups.Serum levels of TSH and FT4 were associated with the total scores of HAMA in CSG （both P〈0.05）.Conclusions The elderly patients in TSH completely suppressive group have more severe anxiety symptoms than the other groups,and their anxiety symptoms are correlated with thyroid dysfunction.The anxiety symptoms may be relieved by adjusting the TSH suppressive levels properly after DTC in elderly patients.