良性甲状腺结节切除术后口服左旋甲状腺素片效果的随访研究

Oral levothyroxine after benign thyroid nodule excision:follow-up study

目的探讨甲状腺结节切除术后复发与口服甲状腺素片的关系。方法选择延安市人民医院住院行甲状腺良性结节手术切除的患者182例,其中,9例接受甲状腺全切除术,173例接受甲状腺叶切除术。术后随访甲状腺素片的口服、甲状腺功能的改变以及超声检查甲状腺结节复发情况。结果所有入选患者均顺利完成手术。术后1d开始口服左旋甲状腺素片,中位口服剂量为25(12.5,50)mg/d。与术前比较,术后7d血清TSH显著减低(P<0.05),血清FT4显著增加(P<0.05)。手术后FT3有轻度下降,但无统计学意义(P>0.05)。随访12月,完成有效随访患者153例,其中按照医嘱规律服药患者83例,未按照医嘱进行规律服药患者70例。随访中,有19例患者复发,其中规律服药组3例(3.6%),未规律服药患者16例(22.9%),差异具有统计学意义(P<0.05)。甲状腺结节复发组术后6月以及术后12月FT4显著减低(P<0.05),术后6月以及术后12月TSH显著增高(P<0.05)。两组FT3无显著差异(P>0.05)。结论甲状腺结节的复发与未规律口服甲状腺素片有显著关系,其中TSH增高可能是复发的关键因素。

Objective The aim of this study was to investigate the relationship between the recurrence of thyroid nodules after thyroidectomy and levothyroxine.Methods A total of 182 patients undergoing benign thyroidectomy were enrolled in the Yan＇an people＇s hospital.Among them,9 patients underwent total thyroidectomy and 173 patients underwent thyroid lobectomy.Follow-up of thyroid hormone tablets,changes in thyroid function,and ultrasound examination of thyroid nodules recurrence.Results All patients were successfully carried out the operation.The mean initial dose of levothyroxine was 25（12.5,50） mg/d.Compared with pre-operation,the TSH was significantly decreased and FT4 was significantly increased（P〈0.05） after 7 days of operation.FT3 decreased slightly after operation,but there was no statistical significance（P〈0.05）.153 cases of effective follow-up were completed,and 83 cases were taken in levothyroxine accordance with the doctor＇s advice（regular medication group）,and 70 patients did not（irregular medication group）.There are 3 cases recrudesced in regular medication group（3.6%）,16 cases were in irregular medication group（22.9%）（P〈0.05）.Compared with no recurrence group,FT4 decreased significantly in 6 month and 12 month after operation in the recurrent group（P〈0.05）,and TSH increased significantly in 6 month and 12 month after operation（P〈0.05） in the recurrent group.Conclusion There is a significant relationship between the thyroid nodules and the irregular oral thyroxine tablets.The increase of TSH may be the key factor for the recurrence of thyroid nodules.