Factors associated with postoperative hypothyroidism after lobectomy in papillary thyroid microcarcinoma patients
Factors associated with postoperative hypothyroidism after lobectomy in papillary thyroid microcarcinoma patients
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DOI：
10.3109/07435800.2014.933975
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发表时间：
2015-01-01
影响因子：
2.1
通讯作者：
Bae, Sang Kyun
中科院分区：
文献类型：
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作者：
Park, Ha Kyoung;Kim, Dong Wook;Bae, Sang Kyun
目的：尚未发表关于术后甲状腺功能与基础甲状腺组织病理学之间相关性的既往研究。本研究旨在探讨甲状腺微小乳头状癌（PTMC）患者行肺叶切除术后甲状腺功能与多种因素的关系。材料和方法：2010年1月至2010年12月，338例因PTMC行甲状腺叶切除术的患者入选。排除术前甲状腺功能亢进或甲状腺功能减退但无术前血清学数据的患者，留下285例患者的队列。分析了术后甲状腺功能（基于成功停止甲状腺素替代治疗）与多种因素（患者年龄和性别、血清学数据、术前甲状腺前后径、甲状腺基础组织病理学和尝试停止甲状腺素替代治疗的次数）之间的关系。结果如下：在285例患者中，157例在肺叶切除术后尝试停止甲状腺素替代治疗一次或两次; 91例在研究期间成功停止甲状腺素替代治疗。术后的最终组织病理学诊断包括桥本甲状腺炎（n = 5）、非桥本型淋巴细胞性甲状腺炎（n = 17）和正常甲状腺实质（n = 135）。术前促甲状腺激素（TSH）水平在术后甲状腺功能减退患者和术后甲状腺功能正常患者之间存在显著差异（单变量logistic回归分析，p = 0.0028;多变量logistic回归分析，p = 0.0029）。任何其他因素均无统计学显著差异。结论：研究结果表明，术前TSH水平是PTMC患者甲状腺叶切除术后发生甲状腺功能减退症的唯一预测因素。
Purpose: No previous study regarding the correlation between post-operative thyroid function and underlying thyroid histopathology has been published. This study assessed the relationship between postoperative thyroid function after lobectomy and multiple factors in papillary thyroid microcarcinoma (PTMC) patients. Materials and methods: From January 2010 to December 2010, 338 patients who had undergone thyroid lobectomy for PTMC were enrolled. Patients with pre-operative hyperthyroidism or those with hypothyroidism but no pre-operative serological data were excluded, leaving a cohort of 285 patients. The relationships between post-operative thyroid function (based on successful cessation of thyroxine replacement therapy) and multiple factors (patient age and sex, serological data, the Preoperative anteroposterior diameter of the thyroid gland, underlying histopathology of the thyroid gland, and number of attempts to stop thyroxine replacement therapy) were analyzed. Results: Out of 285 patients, 157 attempted to stop thyroxine replacement therapy once or twice after lobectomy; 91 successfully stopped thyroxine replacement therapy during the study period. The final histopathologic diagnoses after surgery included Hashimoto's thyroiditis (n = 5), non-Hashimoto type of lymphocytic thyroiditis (n = 17), and normal thyroid parenchyma (n - 135). Pre-operative thyroid-stimulating hormone (TSH) levels differed significantly between patients with postoperative hypothyroidism and those with postoperative euthyroidism (univariate logistic regression analysis, p = 0.0028; multivariate logistic regression analysis, p = 0.0029). No statistically significant differences were found for any other factors. Conclusions: The study results demonstrated that the Pre-operative TSH level was the only predictor for the development of post-operative hypothyroidism after thyroid lobectomy in PTMC patients.