分化型甲状腺癌患者激素水平及促甲状腺激素抑制治疗分析

Analysis of hormone level and TSH suppression therapy in patients with differentiated thyroid carcinoma

目的探讨分化型甲状腺癌患者激素水平,并以此为依据来确定促甲状腺激素(TSH)抑制治疗的介入时间及指导用药。方法选择本院收治的分化型甲状腺癌患者130例为研究对象,均为初次治疗,采用电化学发光免疫法分析患者术后激素水平,按照术式将其分为A、B两组,每组各65例。A组患者行全甲状腺切除,B组患者行单侧腺叶与峡部切除。采集两组患者术后2、4、7及14天空腹静脉血分析甲状腺相关激素水平,至TSH水平>2 m U/L时为止,此时采取TSH抑制治疗并指导用药。结果 A组患者术后TSH水平出现一过性下降,术后第2天开始升高且超过术前,术后第4天超过正常参考值上限;B组患者术后TSH水平也出现一过性下降,术后第2天开始达最低谷随后升高,至术后第7天开始接近术前水平,术后2周超过术前正常参考值上限。两组患者其他甲状腺相关激素水平均出现变化。结论分化型甲状腺癌患者术后激素水平呈动态性变化,可依据这种变化来确定抑制TSH治疗的时间,但具体应参照个体情况,避免出现甲状腺功能亢进。

Objective To investigate the hormone levels in the patients with differentiated thyroid cancer, and to determine the intervention time of TSH suppression therapy. Method 130 cases of differentiated thyroid carcinoma in our hospital were selected as objects of study, all of them were treated for the first time, analyzed the hormone levels of patients after operation by electrochemical immunoassay, according to different surgical methods, they were divided into group A and group B, 65 cases in each group. Patients in group A were treated with total thyroidectmy, patients in group B were treated with one-sided lobe and isthmus resection. Analyzed 2, 4, 7, 14 days after surgery in patients with thyroid associated hormone levels in the two groups. Up to the TSH level 〉2 m U/L, at this time to take TSH suppression therapy and guide medication. Result The TSH level of patients in group A was decreased after operation, and the second day after operation was higher than before operation, and the upper limit of the normal reference value was exceeded the fourth day after operation; the TSH level of patients in group B was decreased after operation also, at the second day after operation began to reach the lowest point and then increased, and at the seventh day after operation was close to the preoperative level, the upper limit of the normal reference value was exceeded 2 weeks after operation. Other thyroid hormone levels of the two groups were changed. Conclusion Hormone levels of differentiated thyroid cancer after operation have a dynamic of change, such changes can be determined according to TSH suppression therapy, but also with reference to specific individual cases, to avoid hyperthyroidism.