The Recovery of Thyroid Function in Low-Risk Papillary Thyroid Cancer After Lobectomy: A 3-Year Follow-Up Study.
The Recovery of Thyroid Function in Low-Risk Papillary Thyroid Cancer After Lobectomy: A 3-Year Follow-Up Study.
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DOI：
10.3389/fendo.2020.619841
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发表时间：
2020
影响因子：
5.2
通讯作者：
Su X
中科院分区：
文献类型：
--
作者：
Dou Y;Chen Y;Hu D;Su X
低风险甲状腺乳头状癌（PTC）肺叶切除术后的管理策略存在争议。本研究旨在确定低风险PTC患者中不需要激素替代治疗的患者比例，并评估肺叶切除术后甲状腺功能减退症的风险因素。回顾性分析了2017年1月至2018年12月接受甲状腺叶切除术的190例PTC患者的记录。收集临床病理特征和随访资料。单因素和多因素分析，以确定与术后甲状腺功能减退症和甲状腺功能恢复的危险因素。总之，74.21%（141/190）的患者在未补充左旋甲状腺素的情况下甲状腺功能正常，而40.53%（77/190）的患者发生暂时性或永久性甲状腺功能减退。多因素分析显示术前促甲状腺激素（TSH）水平较高（>2.62 mIU/L）、桥本氏甲状腺炎（HT）和右叶切除术与甲减相关（均P<0.05）。Logistic分析的曲线下面积（AUC）为0.829。28例（28/77，36.4%）患者在术后第一年恢复到甲状腺功能正常状态，这种恢复与术前TSH水平显著相关。49例（49/77，63.6%）患者出现持续性甲状腺功能减退症。大部分患者（11/28，39.3%）的甲状腺功能在术后3个月恢复。术前TSH水平较低、左叶切除且无桥本甲状腺炎的患者在叶切除术后第一年内甲状腺功能正常的机会较高。甲状腺功能恢复与术前TSH水平有关。
Management strategies after lobectomy for low-risk papillary thyroid carcinoma (PTC) are controversial. This study aimed to identify the proportion of patients among low-risk PTC patients who do not require hormone replacement therapy and to evaluate the risk factors for postoperative hypothyroidism after lobectomy. The records of 190 PTC patients who underwent thyroid lobectomy from January 2017 to December 2018 were retrospectively reviewed. Clinicopathological characteristics and follow-up data were collected. Univariate and multivariate analyses were performed to identify the risk factors associated with postoperative hypothyroidism and the recovery of thyroid function. In summary, 74.21% of patients (141/190) had normal thyroid function without levothyroxine supplementation, while 40.53% (77/190) developed temporary or permanent hypothyroidism. Multivariate analysis indicated that higher preoperative thyroid-stimulating hormone (TSH) levels (>2.62 mIU/L), Hashimoto’s thyroiditis (HT), and right lobectomy were associated with hypothyroidism (all P<0.05). The Area Under Curve (AUC) by logistic analysis was 0.829. Twenty-eight (28/77, 36.4%) patients recovered to the euthyroid state in the first year after surgery, and this recovery was significantly associated with preoperative TSH level. Forty-nine (49/77, 63.6%) patients developed persistent hypothyroidism. The thyroid function of most patients (11/28, 39.3%) recovered in the third month after surgery. Patients with a lower level of preoperative TSH, with left lobectomy and without Hashimoto’s thyroiditis had a higher chance of normal thyroid function within the first year after lobectomy. The recovery of thyroid function was associated with the level of preoperative TSH.
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DOI：
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期刊：
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