回顾性分析甲状腺乳头状癌患者术后TSH抑制治疗达标的影响因素

The influencing factors of TSH suppressive therapy in patients with papillary thyroid carcinoma after surgery were analyzed retrospectively

目的比较甲状腺乳头状癌患者术后促甲状腺激素(TSH)抑制治疗达标组与未达标组各项观察指标,分析甲状腺乳头状癌患者术后TSH抑制治疗时TSH水平达标的影响因素。方法选取2018年1月~2019年7月于新疆维吾尔自治区人民医院住院行手术后病理确诊为甲状腺乳头状癌并术后TSH抑制治疗的患者237例,根据术后12个月时的TSH水平分TSH水平达标组与未达标组,比较两组患者一般资料(性别、年龄),术前血清游离三碘甲状腺原氨酸(FT3)、血清游离甲状腺素(FT4)、血清促甲状腺激素(TSH)、BRAF基因突变、淋巴结转移以及术后FT3、FT4,左旋甲状腺激素钠剂量等。结果共有237例患者被纳入本研究,男女比例为1∶3.56。根据12个月时的TSH水平,达标组患者为71例,平均年龄(48.42±9.76)岁,男女比例为1∶3.17,术前淋巴结转移患者24例(33.8%),BRAF基因突变患者59例(83%),术前TSH≥2.0 mIU/L的有20例(28.17%),无复发患者;未达标组患者166例,男女比例1∶3.74,平均年龄(46.50±10.25)岁,淋巴结转移患者为51例(30.7%),BRAF基因突变患者129例(77.7%),术前TSH≥2.0 mIU/L的有99例(59.64%),无复发患者。结论甲状腺乳头状癌患者术前TSH≥2.0 mIU/L的患者更有可能表现出术后TSH水平不达标的情况。对甲状腺乳头状癌术后患者实施抑制剂量左旋甲状腺素治疗TSH水平达标时,可更好改善甲状腺功能。对术后患者每次随访根据结果应及时调整左旋甲状腺激素剂量,以免因剂量不足而导致TSH水平抑制不达标。

Objective To compare the observation indicators between the standard-reaching group and the standard-failing group of postoperative TSH suppressive therapy in patients with papillary thyroid carcinoma,and to analyze the influencing factors of TSH level reaching the standard in patients with papillary thyroid carcinoma after postoperative TSH suppressive therapy.Methods Patients admitted to the People's Hospital of Xinjiang Uygur Autonomous Region from January 2018 to July 2019 who were pathologically diagnosed as thyroid papillary carcinoma after surgery and treated with postoperative TSH suppressive therapy were selected.According to the TSH level 12 months after surgery,the patients were divided into TSH level standard-reaching group and standard-group,and the general data(gender and age),serum free triiodothyronine(FT3),serum free thyroxine(FT4),serum thyroid stimulating hormone(TSH),BRAF gene mutation,lymph node metastasis,and postoperative FT3,FT4,levothyroxine sodium dose of the two groups were compared.Results A total of 237 patients were included in this study,with a male to female ratio of 1∶3.56.Based on the TSH level at 12 months,71 patients in the standard-reaching group,mean age was(48.42±9.76)years.The male to female ratio was 1∶3.17,24 patients(33.8%)with preoperative lymph node metastasis,59(83%)patients with BRAF gene mutations,20(28.17%)patients of preoperative TSH≥2.0 mIU/L,no patients with recurrence;166 patients in the standard-failing group,male to female ratio of 1∶3.74,mean age was(46.50±10.25)years.Lymph node metastasis was 51(30.7%),129 patients(77.7%)with BRAF gene mutations,99(59.64%)patients of preoperative TSH≥2.0 mIU/L,no patients with recurrence.Conclusion Patients with TSH≥2.0 mIU/L before operation are more likely to show substandard TSH after operation.Inhibitory dose of levothyroxine can improve thyroid function in patients with papillary thyroid carcinoma after operation.The dose of levothyroxine should be adjusted timely according to the results of each follow-up to avoid substandard inhibition of TSH level due to insufficient dose.