Thyroid Hormone Supplementation Therapy for Differentiated Thyroid Cancer After Lobectomy: 5 Years of Follow-Up
Thyroid Hormone Supplementation Therapy for Differentiated Thyroid Cancer After Lobectomy: 5 Years of Follow-Up
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DOI：
10.3389/fendo.2020.00520
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发表时间：
2020-07-31
影响因子：
5.2
通讯作者：
Park, Cheong Soo
中科院分区：
文献类型：
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作者：
Kim, Soo Young;Kim, Hee Jun;Park, Cheong Soo
背景：保留对侧甲状腺叶的甲状腺叶切除术已成为低危甲状腺癌患者的首选手术方式。甲状腺癌肺叶切除术后甲状腺功能减退症的发生率和风险因素尚不清楚。甲状腺切除术后补充左旋甲状腺素以抑制促甲状腺激素（TSH）的既往实践有一些严重的副作用。本研究旨在评估甲状腺功能减退症的发病率，并确定与甲状腺功能减退症需要甲状腺激素替代治疗相关的因素。方法：我们回顾性分析了2014年4月至12月在江南Severance医院接受肺叶切除术治疗的256例分化型甲状腺癌患者的病历，这些患者随访超过5年。在第1年每6个月的门诊访视时使用甲状腺功能测试对患者进行评估，此后每年进行一次随访。结果：5年后，66.0%（169）的患者需要补充左旋甲状腺素以维持甲状腺功能正常。需要补充左旋甲状腺素的甲状腺功能减退症的发病率增加，直到3年，但在第4和第5年没有显着变化。复发率在补充和不补充左旋甲状腺素组之间没有差异。在单变量和多变量分析中，甲状腺炎的存在和术前TSH水平与术后补充左旋甲状腺素以维持甲状腺功能正常状态相关。结论：术前高TSH水平和/或甲状腺炎表明甲状腺叶切除术后发生甲状腺功能减退症的可能性显著增加，需要补充甲状腺激素。术后甲状腺功能减退风险增加的患者必须了解其风险因素，并应进行更密集的随访。
Background:Lobectomy with preservation of the contralateral lobe has already become the most preferred surgical method for patients with low-risk thyroid cancer. The incidence of and risk factors for the development of hypothyroidism after lobectomy for thyroid cancer remains unclear. The previous practice of levothyroxine supplementation post-thyroidectomy, to bring about thyroid stimulating hormone (TSH) suppression, had some serious side effects. This study aimed to evaluate the incidence of hypothyroidism and to identify the factors associated with hypothyroidism requiring thyroid hormone replacement. Methods:We retrospectively reviewed the charts of 256 consecutive patients with differentiated thyroid cancer treated with lobectomy at the Gangnam Severance Hospital between April and December 2014 who were followed-up for more than 5 years. Patients were evaluated using a thyroid function test at the time of outpatient visit every 6 months for the 1st year, with an annual follow-up thereafter. Results:After 5 years, 66.0% (169) of the patients needed levothyroxine supplementation to maintain euthyroid status. The incidence of hypothyroidism requiring levothyroxine supplementation increased until 3 years but showed no significant change in the 4 and 5th year. Recurrence showed no difference between the group with and without levothyroxine supplementation. The presence of thyroiditis and preoperative TSH levels were correlated with postoperative levothyroxine supplementation to maintain euthyroid status, in univariate and multivariate analyses. Conclusion:High preoperative TSH levels and/or thyroiditis indicate a significantly increased likelihood of developing hypothyroidism requiring thyroid hormone supplementation after a thyroid lobectomy. Patients with an increased risk of postoperative hypothyroidism must be aware of their risk factors and should undergo more intensive follow-ups.