分化型甲状腺癌术后^(131)I治疗对甲状旁腺功能影响的临床分析

Effect on parathyroid function after 131I treatment for post-surgical differentiated thyroid carcinoma

目的探讨分化型甲状腺癌(DTC)术后131I清除残留甲状腺组织(简称清甲)治疗对患者短期内甲状旁腺功能的影响。方法 DTC患者共27例,术后行B超检测残留甲状腺大小。术后1个月均给予131I100mci进行清甲治疗。治疗前1d、治疗后3个月分别空腹采血检测甲状旁腺激素(PTH)、血清钙和磷水平,并询问患者是否有手足抽搐、四肢麻木或感觉异常等。将患者分为全切组(A组,16例残留甲状腺最大径大于或等于1cm)和次全切组(B组,11例,残留甲状腺最大径小于1cm)。将27例患者的血PTH、钙和磷在治疗前、后进行比较,并将A、B组的血PTH、钙和磷在治疗前、后进行比较。结果 27例患者清甲治疗后PTH水平(1.76±0.93)pmol/L较治疗前(2.31±1.22)pmol/L下降(t=2.69,P=0.012),血钙、磷水平变化差异无统计学意义(P>0.05);无一例患者清甲治疗后出现手足抽搐、四肢麻木等低钙血症表现。A、B组的PTH、血钙、血磷在治疗前比较差异均无统计学意义(P>0.05),治疗后比较差异也均无统计学意义(P>0.05)。27例患者清甲治疗后PTH水平较治疗前下降者19例,其中,A组11例(68.75%),B组8例(72.73%),两组比较差异无统计学意义(χ2=0.049,P=0.824)。结论 131I治疗可导致DTC患者短期内PTH水平降低,这种变化与残留甲状腺组织多少无关,且一般不会引发低钙血症。

Objective To analyze the short-term effect on parathyroid function after 131I treatment for post-surgical differentiated thyroid carcinoma（DTC）. Methods Twenty-seven DTC patients treated with 100 mci 131I after one month of thyroidecto- my were enrolled in the study,the size of residual thyroid was detected by B ultrasound after operation. One days before treatment, 3 months after treatment, fasting blood samples were taken to detect parathyroid hormone（PTH）,serum calcium and phosphorus, and asked whether the patient had a hand, foot, convulsions, numbness or sensory abnormalities, etc.. Patients were divided into two groups according to ultrasound findings in neck：group A with total thyroidectomy（n= 16,the maximum diameter of residual thyroid tissue ≥1 em）and group B with subtotal thyroidectomy（n=11 the maximum diameter of residual thyroid tissue〈1 era）. Then serum PTH ,Ca2＋ arid P levels were evaluated at baseline and at three months after 131I administration,and the patientsr clinical symptoms of hypocalcemia were analyzed. Results The blood PTH level after treatment（1.76 ± 0.93）pmol/L in 27 DTC patients was decreased than before treatment（2.31±1.22）pmol/L（t=2.69 ,P=0. 012）, blood Ca2＋ and P values change had no statistical significance（P〉0.05）. No patients experienced tetany,limb numbness and hypocatcemia after treatment. The PTH,blood Caz＋ and P phosphorus had no statistical significance between the two groups before and after treatment （P〉0.05）. The blood PTH levels of 27 cases of patients decreased after treatment than before treatment in 19 cases, among them, 11 cases（68.75%）in group A and 8 cases in group B（72.73%） ,there was no statistically significant differences between the two groups（X2 =0. 049,P=0. 824）. Conclusion 131I treatment for DTC can result in decreasing PTH levels in the short-term,which these changes are irrelevant to quantity of residual thyroid mass and can not induce hypoealcemia.