不同中医证型的甲状腺手术前后甲状腺激素的变化分析

Analysis of the Changes of Thyroid Hormone before and after Thyroidectomy with different TCM Syndromes

目的探讨不同中医证型的甲状腺单侧切除手术前后甲状腺激素的变化差异。方法选取2019年7月至2021年1月间在上海市青浦区中医医院行甲状腺单侧切除术的患者55例,术前按照不同中医证型分为三组:A组为痰瘀互结证患者n=26;B组为脾肾阳虚证患者n=13;C组为肝郁痰凝证患者n=16,统计分析术前术后三组各项甲状腺激素变化差异。结果术前为痰瘀互结证患者,术后2周、术后3个月TT3、FT3、TSH水平与术前比较,无显著差异(P>0.05),术后2周及3个月后TT4、FT4水平相较于术前明显升高,差异有统计学意义(P<0.05),本组患者未出现亚临床甲减或甲状腺功能减退症。术前为脾肾阳虚证患者,术后2周,术后3个月TT3、FT4水平与术前比较,无显著差异(P>0.05),术后2周及3个月TT4水平相较于与术前显著升高,差异有统计学意义(P<0.05),术后2周FT3和TSH与术前比较,无显著差异(P>0.05),术后3个月与术前比较,显著降低,差异有统计学意义(P<0.05),本组患者未出现临床甲减货甲状腺功能减退症。术前为肝郁痰凝证患者,术后2周,术后3个月TT3、TT4、FT4水平与术前比较,无显著差异(P>0.05),术后2周FT3水平与术前比较,无显著差异(P>0.05),术后3个月明显降低,差异有统计学意义(P<0.05),术后2周,术后3个月TSH水平相较于术前均明显升高,差异有统计学意义(P<0.05),本组病例在术后2周,术后3个月有临床甲状腺功能减退症出现,共16例,其中9例出现甲减症状,占比为56.25%,此类病人临床增加优甲乐用量。一个月后进行复查,甲状腺功能指标和甲减症状均有好转。结论三种中医证型在术前术后相同用药的情况下,在术后2周、术后3个月甲状腺激素有显著变化。

Objective To investigate the difference of thyroid hormone before and after unilateral thyroidectomy of different TCM syndrome types.Methods A total of 55 patients with unilateral thyroidectomy from July 2019 to January 2019 in Qingpu District Hospital of traditional Chinese medicine were divided into three groups according to different TCM syndrome types:group A was the patients of phlegm-blood stasis syndrome(N=26);group B was the patient of Yang deficiency of spleen and kidney(N=13)and group C was liver depression and phlegm coagulation syndrome(N=16).The changes of each thyroid hormone before and after operation were statistically analyzed.Results The patient with phlegm and blood stasis syndrome before operation,there was no significant difference(P>0.05)in the levels of TT3,FT3 and TSH between 2 weeks and 3 months after operation.The levels of TT4 and FT4 in 2 weeks and 3 months after operation were significantly higher than before operation,the difference was statistically significant(P<0.05).There was no subclinical hypothyroidism or hypothyroidism in this group.the patient with spleen and kidney Yang deficiency before operation,there was no significant difference in TT3 and FT4 levels between 2 weeks and 3 months after operation(P>0.05).TT4 levels in 2 weeks and 3 months after operation were significantly higher than those before operation(P<0.05),there was no significant difference in FT3 and TSH between 2 weeks after operation and before operation(P>0.05).There was significant difference in FT3 and TSH between 3 months after operation and before operation(P<0.05).There was no clinical hypothyroidism in this group.The patient with liver depression and phlegm coagulation before operation,there was no significant difference in the levels of TT3,TT4 and FT4 between 2 weeks and 3 months after operation(P>0.05).There was no significant difference in the levels of FT3 between 2 weeks after operation and before operation(P>0.05),there was a significant decrease 3 months after the operation,there was significant difference(P<0.05).The TSH level at 2 weeks and 3 months after operation was significantly higher than that before operation(P<0.05),there were 16 cases of clinical hypothyroidism 3 months after operation,among which 9 cases(56.25%)had symptoms of hypothyroidism.A follow-up examination will be conducted in1 month,thyroid function index and hypothyroidism symptoms were improved.Conclusion The three TCM syndrome types have significant changes in two weeks and Thyroid hormone after operation under the condition of using the same medicine before and after operation.