分化型甲状腺癌的甲状腺激素治疗:当前实践的反思

Thyroid hormone treatment of differentiated thyroid cancer:Reflection on current practices

甲状腺激素治疗是分化型甲状腺癌(differentiated thyroid cancer,DTC)术后管理的重要组成部分,其目的是控制促甲状腺激素(thyrotropin,TSH)水平,帮助患者恢复正常的甲状腺功能并降低肿瘤复发风险。随着疾病持续/复发风险分层系统等的进一步优化,TSH抑制带来的效益和风险也受到更多的审视。对复发中高危的DTC患者,要结合术后初治期和随访期长期的动态评估,制定合适的TSH控制目标。对复发低危患者,左旋甲状腺素(levothyroxine,LT 4)补给的剂量应做相应调整,避免TSH的过度抑制。进一步认识临床实践中复发风险不同的DTC患者甲状腺激素治疗带来的利与弊,有助于推动DTC术后的管理水平。

Thyroid hormone therapy is the mainstay of differentiated thyroid cancer(DTC)management after surgery.By controlling thyrotropin within target levels,it hopes that patients could restore euthyroidism state and lower recurrence rates.However,thyroid hormone treatment has been facing challenges in termso of lenefit-risk assessment since the improved risk stratification system of persistent/recurrent disease was into use.Clinicians should weigh the potential benefits against downsides based on initial risk of disease and ongoing risk assessment of disease status.The optimal TSH level for patients with an intermediate-or high-risk for recurrence is to maintain the beneficial effects on tumor recurrence without increasing the risk of adverse events.Levothyroxine should be titrated to avoid excessive TSH suppression for low-risk patients.Only with holistic benefit-risk analysis of thyroid hormone therapy,can we further promote the quality of postoperative DTC management.