单侧甲状腺切除术后甲状腺激素水平的临床研究

Clinical Study of Thyroid Hormone Levels After Unilateral Thyroidectomy

目的:探讨单侧甲状腺切除术后甲状腺激素水平的变化及治疗建议。方法 :选取我科2010年1月至2012月12月收治的非恶性甲状腺肿块并行单侧甲状腺切除患者122例,根据病检结果分为结节性甲状腺肿组和非结节性甲状腺肿组,结节性甲状腺肿组术后常规给予优甲乐片口服,非结节性甲状腺肿组均在术后3月根据甲状腺功能决定是否给药。每组内再次按照年龄分为55岁以上组和55岁以下组两个亚组,检测各组患者术前及术后1、2、3、6、12个月游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)和促甲状腺激素(TSH)水平。结果:55岁以下未服用优甲乐组,术后1、2月FT3、FT4较术前无明显差异,TSH较术前稍高,但术后3、6、12月FT3、FT4、TSH均与术前无差异;55岁以上未服用优甲乐组,术后1、2、3月FT3、FT4较术前明显降低,TSH较术前明显升高。在服用优甲乐组中,两亚组术前、术后激素水平无明显差异。结论:单侧甲状腺切除术后甲状腺激素水平与年龄存在一定相关性,55岁以下术后出现一过性亚临床甲减,能自行恢复,故不需要药物干预;55岁以上患者术后出现甲状腺功能减退,故术后需要行药物干预,剂量可选用25μg口服每日1次。

Objective To investigate the changes of thyroid hormone levels and to discuss the recommended treatment after unilateral thyroidectomy. Methods From January 2010 to December 2012,122 patients with non-malignant thyroid tumor that underwent unilateral thyroidectomy in our hospital were divided into nodular goiter group and non-nodular goiter group based on pathologic results. Euthyrox tablets were orally administrated in patients of nodular goiter group after thyroidectomy, whether the patients of non-nodular group need administration depended on the thyroid function at 3 months after operation. The two groups were divided into two subgroups according to the age below or over 55 years old, and then the levels of triiodothyronine （ FT3 ）, free thyroxine （FT4） and thyroid stimulating hormone （TSH） were detected at pre-operation and 1,2,3, 6,12 months post-operation. Results In the subgroup that below 55 years old without taking euthyrox,the levels of FT3 and FT4 had no significant difference at 1,2 months post-operation, but the level of TSH was increased compared with pre-operation, and then the three indexes had no significant difference at 3,6,12 months post-operation compared with pre-operation. In the subgroup that over 55 years old without taking euthyrox,the levels of FT3 and FT4 were significantly decreased at 1, 2,3 months post-operation, but the level of TSH was incr6ased compared with pre-operation. In groups that taking euthyrox, the levels of FT3 ,FT4 and TSH post-operation had no significant difference with pre-operation. Gonclusion The thyroid hor- mone level after unilateral thyroidectomy may be related with age. Transient subclinical hypothyroidism occurred in patients below 55 years old, which could self recovery and no need for intervention. While in patients over 55 years old, the symptom of hypothyroidism needs drug intervention, and the recommended dose of euthyrox tablets is 25 μg orally once daily.