分化型甲状腺癌术后促甲状腺激素抑制治疗时机的选择

Selection of Thyrotropin Suppression Therapeutic Timing in Postoperative Patients with Differentiated Thyroid Carcinoma

目的观察分化型甲状腺癌患者术后相关激素水平的变化,以探讨最佳促甲状腺激素(TSH)抑制治疗的时机。方法搜集2011年1月至2013年12月期间我院96例初始治疗的分化型甲状腺癌患者,按手术方式分为全甲状腺切除组(n=50)和患侧腺叶及峡部切除组(n=46),分别于术后第1、2、4、5、7、14 d检测患者血清甲状腺相关激素即三碘甲状腺原氨酸(T3)、游离三碘甲状腺原氨酸(FT3)、甲状腺激素(T4)、游离甲状腺激素(FT4)及TSH。结果 1全甲状腺切除组患者,术后血清T3、FT3水平除第5 d一过性升高外,总体较术前呈下降趋势,至术后第14 d时其水平低于正常参考值。T4、FT4水平在术后出现短暂升高后,至术后第4 d时开始下降,至术后第14 d时T4水平仍于正常值范围内,FT4降至正常参考值范围以下。血清TSH在术后第1 d呈一过性降低,术后第2 d开始升高,至术后第4 d时超过正常参考值上限,随后继续升高。2患侧腺叶及峡部切除组患者,术后血清T3、FT3水平较术前呈降低趋势,至第5 d起开始升高,但至术后第14 d时仍低于术前水平。血清T4、FT4术后呈升高趋势,于术后第2 d达高峰后随后下降,至术后第14 d时其水平仍在正常值范围内。术后血清TSH先降低,术后第4 d开始升高,于术后第7 d超过术前水平,术后14 d达正常参考值上限。结论分化型甲状腺癌术后患者相关激素呈动态变化,临床应该根据其激素水平变化确定开始TSH抑制治疗时间。当术后TSH水平高于正常参考值范围时,可作为启动TSH抑制治疗的最佳时机。

Objective To observe changing trend of thyroid hormones levels for postoperative patients with differentiated thyroid carcinoma, and to discuss the best therapeutic timing of thyrotropin（TSH） suppression. Methods Ninety-six patients with differentiated thyroid carcinoma from January 2011 to December 2013 in this hospital were selected. All of these 96 cases were divided into total thyroidectomy group（n=50） and thyroid lobectomy and isthmectomy group（n=46） according to the surgical approach. Serum thyroid hormones levels（T3, FT3, T4, FT4, and TSH） were detected on day 1, 2, 4, 5, 7, 14 after operation. Results 1 In the total thyroidectomy group, the levels of T3 and FT3 elevated transiently on day 5, then decreased gradually, and which were lower than the low limit of normal range on day 14. The levels of T4 and FT4 elevated transiently, then reached the peak on day 2, and which started to decrease gradually and reached the low limit of normal range on day 14. The value of serum TSH decreased transiently, which started to increase rapidly on day 2 and surpassed the high limit of normal range on day 4, then continued to rise until on day 14. 2 In the lobectomy and isthmectomy group, the values of T3 and FT3 decreased gradually, then started to rise on day 5, and which were lower than preoperative values until on day 14. The values of T4 and FT4 elevated transiently and which reached the peak on day 2, and then gradually decreased, which appeared to be lower than preoperative values on day 14. The value of TSH decreased transiently, and which started to rise on day 4, then elevated gradually and exceeded preoperative level on day 7, which reached the high limit of normal range on day 14. Conclusions There are dynamic changes of thyroid hormones in postoperative patients with differentiated thyroid carcinoma. It is feasible to determine the best therapeutic timing of TSH suppression according to the levels of postoperative thyroid hormones. The best timing of thyrotropin suppression therapy is that TSH is above the high limit of normal range after operation.