分化型甲状腺癌术后相关激素水平及TSH抑制治疗合适介入时间的研究

Appropriate Levels of Related Hormones and TSH Suppression in Patients with Differentiated Thyroid Cancer after Surgery

目的研究分化型甲状腺癌术后相关激素水平,探讨TSH抑制治疗的介入时间。方法选取分化型甲状腺癌患者60例,采用电化学免疫法观察术后相关激素水平变化动态。根据手术方式不同分为2组,各30例。A组行全甲状腺切除,B组行单侧腺叶及峡部切除。A组在手术后第1、2、4、5、7天空腹静脉抽取血样检测甲状腺相关激素,B组在手术后第2、4、7、14天空腹静脉抽取血样检测甲状腺相关激素,若TSH超过3 m U/L或持续3次上升,则进行促甲状腺素(TSH)抑制治疗。结果 60例患者术后甲状腺相关激素水平均出现变化,A组术后血清三碘甲腺原氨酸(T3)、游离三碘甲腺原氨酸(FT3)逐渐下降;血清甲状腺素(T4)、游离血清甲状腺素(FT4)术后第2天水平最高,而后下降至参考值低限下;血清TSH术后第2天水平最低,第2天后开始升高并迅速超过参考值高限。B组术后血清T3、FT3在手术后第3天水平最低,后逐渐升高但仍低于术前;术后血清T4、FT4水平第2天最高,后在逐渐下降且低于术前;术后血清TSH第2天水平最低,后逐渐升高,1周后接近术前水平,2周后达到参考值高限。结论根据分化型甲状腺癌术后相关激素水平动态变化可判断术后进行TSH抑制治疗的介入时间;全甲状腺切除在术后(5±2)天、单侧腺叶及峡部切除在术后(9±2)天介入TSH抑制治疗。

Objective To study the levels of related hormones in differentiated thyroid carcinoma after operation,and to discuss the appropriate interventional time of TSH.Methods 60 cases of differentiated thyroid carcinoma were selected.The changes of related hormone levels were observed by electrochemical immunoassay.The patients were divided into 2 groups according to the operation methods,A group,30 cases with total thyroidectomy,and 30 cases of unilateral lobe and isthmus resection in group B.In group A,fasting venous blood samples were taken from the first,second,fourth,fifth,seventh days after surgery to detect thyroid related hormones,in group B,fasting venous blood samples were taken from the second,fourth,seventh,fourteenth days after operation for detection of thyroid related hormones.If TSH is more than 3 mU/L or rising for 3 times,give thyrotropin(TSH)inhibition therapy.Results The levels of thyroid related hormones were changed in 60 patients after operation.In group A,three serum triiodothyronine(T3)and free three triiodothyronine(FT3)after operation decreased,serum thyroxine(T4)and free thyroxine(FT4)after second days of operation reached the highest level,and then decreased to the lower limit of the reference value,the serum TSH second days after operation reached the lowest level,and then began to rise and quickly over the reference value of the high limit.In group B,serum levels of T3 and FT3 in third days after surgery reached the lowest level,then gradually increased but still lower than that before surgery;the level of serum T4 and FT4 reached the highest for second days after operation,and then decreased gradually and lower than before operation;serum TSH level reached the minimum for the second day after operation,and then increased gradually after,and close to the preoperative level in 1 week,reaching the high limit reference value after after 2 weeks.Conclusion According to the dynamic changes of related hormones after differentiated thyroid carcinoma,the time of interventional therapy for TSH can be determined.Total thyroidectomy is performed at(5±2)days after operation,and the unilateral lobe and isthmus resection group is treated with TSH suppression(9±2)days after surgery.