甲状腺乳头状微小癌的术后管理及动态风险评估

Postoperative management and risk stratification of papillary thyroid microcarcinoma

规范化的术后管理同样是甲状腺微小癌治疗的重要组成部分，包括初治期及随访期。初治期术后管理基于初治期复发风险分层，初治复发风险分层确立后可指导初治的TSH抑制治疗及RAI辅助治疗，并指导后续随访计划的制定，但初治复发风险分层作为一种静态病情评估，不能有效反映患者术后长时间状态变化。随访期术后管理应依据术后长期随访的所有资料对患者进行复发风险再分层。复发风险再分层确立后可指导TSH抑制治疗程度的调整、随访计划及相应治疗方案的制定。兼顾TSH抑制治疗副作用风险，根据双风险评估体系，制定TSH抑制目标值，以达到保证治疗效果同时，最大限度提升患者生活质量的目的。

The postoperative management of papillary thyroid microcarcinoma （PTMC） is one of the most important parts of management for PTMC, and it includes the initial management and long-term management of PTMC. The initial management of thyroid cancer is based on initial recurrence risk stratification system. The ini- tial risk stratification system can be used to guide initial TSH suppression therapy, RAI assistant therapy and management of follow up. Initial risk assessment of recurrence, as a static representation of the patient in the first few weeks post-operatively, could not be continually updated during follow up. In order to account for the changes of the recurrence risk and disease specific mortality, re-stratification of risk should be performed during follow up, using all the clinical, biochemical, imaging （structural and functional）, and cytopathologic findings obtained dur- ing follow up. Re-stratification of risk can inform clinicians on degree of ongoing TSH suppression, frequency and intensity of follow-up, and need for additional therapies were recommended in guideline. Adjustment of TSH sup- pression therapy should incorporate the impact of side effects and set TSH targets to ensure the benefits of TSH suppression outweigh against the potential risks.