Selection of Thyrotropin Suppression Therapeutic Timing in Postoperative Patients with Differentiated Thyroid Carcinoma_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 XUJun , LIPeng , XIAOGuang-xiong , JINZhe-long , ZHANGHao , LIJing , HULing

Department of Thyroid and Breast Surgery, Jingmen No.1 People's Hospital, Jingmen 448000, Hubei Province, China;

Corresponding?author：

XUJun, Email: zhangzhengchao3@126.com

Keywords：

Thyroid carcinoma; Thyrotropin; Suppression therapy

DOI：

10.7507/1007-9424.20160053

Video：

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Objective To observe changing trend of thyroid hormones levels for postoperative patients with differentiated thyroid carcinoma,and to discuss the best therapeutic timing of thyrotropin (TSH) suppression. Methods Ninety-six patients with differentiated thyroid carcinoma from January 2011 to December 2013 in this hospital were selected.All of these 96 cases were divided into total thyroidectomy group (n=50) and thyroid lobectomy and isthmectomy group (n=46) according to the surgical approach.Serum thyroid hormones levels (T3,FT3,T4,FT4,and TSH) were detected on day 1,2,4,5,7,14 after operation. Results ① In the total thyroidectomy group,the levels of T3 and FT3 elevated transiently on day 5,then decreased gradually,and which were lower than the low limit of normal range on day 14.The levels of T4 and FT4 elevated transiently,then reached the peak on day 2,and which started to decrease gradually and reached the low limit of normal range on day 14.The value of serum TSH decreased transiently,which started to increase rapidly on day 2 and surpassed the high limit of normal range on day 4,then continued to rise until on day 14.② In the lobectomy and isthmectomy group,the values of T3 and FT3 decreased gradually,then started to rise on day 5,and which were lower than preoperative values until on day 14.The values of T4 and FT4 elevated transiently and which reached the peak on day 2,and then gradually decreased,which appeared to be lower than preoperative values on day 14.The value of TSH decreased transiently,and which started to rise on day 4,then elevated gradually and exceeded preoperative level on day 7,which reached the high limit of normal range on day 14. Conclusions There are dynamic changes of thyroid hormones in postoperative patients with differentiated thyroid carcinoma.It is feasible to determine the best therapeutic timing of TSH suppression according to the levels of postoperative thyroid hormones.The best timing of thyrotropin suppression therapy is that TSH is above the high limit of normal range after operation.

Citation： XUJun, LIPeng, XIAOGuang-xiong, JINZhe-long, ZHANGHao, LIJing, HULing. Selection of Thyrotropin Suppression Therapeutic Timing in Postoperative Patients with Differentiated Thyroid Carcinoma. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2016, 23(2): 206-209. doi: 10.7507/1007-9424.20160053 Copy

1.	?趙琳, 李志劍. 北京市人群健康及相關生活方式的調查報告. 中西醫結合心腦血管病雜志, 2014, 12(8):1021-1022.
2.	中華醫學會內分泌學分會, 中華醫學會外科學分會內分泌學組, 中國抗癌協會頭頸腫瘤專業委員會, 等. 甲狀腺結節和分化型甲狀腺癌診治指南. 中華內分泌代謝雜志, 2012, 28(10):779-797.
3.	黃韜. 分化型甲狀腺癌的規范治療. 中國普外基礎與臨床雜志, 2012, 19(8):805-808.
4.	馬峻峰, 唐波, 李鐵漢, 等. 促甲狀腺激素抑制療法在分化型甲狀腺癌治療中的作用. 中國普外基礎與臨床雜志, 2009, 16(5):348-350, 355.
5.	閆慧賢, 呂朝暉. 分化型甲狀腺癌TSH抑制治療的雙風險評估. 藥品評價, 2014, 11(3):34-37.
6.	王松, 張方潔, 代文杰, 等. 分化型甲狀腺癌術后的TSH抑制治療. 中華普通外科雜志, 2014, 29(4):295-298.
7.	屈丹, 姜雅秋. 急性低血糖大鼠血清 FT3、FT4、TSH 水平及下丘腦組織 TRH 表達變化. 山東醫藥, 2015, 55(31):30-32.
8.	費成英. 血清TT3、FT3、TT4、FT4以及TSH檢測意義. 國際檢驗醫學雜志, 2010, 31(2):121-122.
9.	Diessl S, Holzberger B, M?der U, et al. Impact of moderate vs stringent TSH suppression on survival in advanced differentiated thyroid carcinoma. Clin Endocrinol (Oxf), 2012, 76(4):586-592.
10.	Tuttle R, Ball D, Byrd D, et al. NCCN clinical practice guidelines in oncology (NCCN Guidelines^{^?}):Thyroid carcinoma version 2.2012. Fort Washington (PA):National Comprehensive Cancer Network, 2012.
11.	蘇艷軍, 楊婷婷, 張建明, 等. 甲狀腺術后的甲狀腺功能維護. 國際外科學雜志, 2014, 41(2):114-119.
12.	Gudmundsson J, Sulem P, Gudbjartsson DF, et al. Discovery of common variants associated with low TSH levels and thyroid cancer risk. Nat Genet, 2012, 44(3):319-322.
13.	Fiore E, Vitti P. Serum TSH and risk of papillary thyroid cancer in nodular thyroid disease. J Clin Endocrinol Metab, 2012, 97(4):1134-1145.
14.	Sherman SI. Targeted therapies for thyroid tumors. Mod Pathol, 2011, 24(Suppl 2):S44-S52.
15.	白耀, 連小蘭. 分化型甲狀腺癌患者需要個體化的TSH抑制. 中華內分泌代謝雜志, 2011, 27(6):451-453.
16.	McLeod DS, Watters KF, Carpenter AD, et al. Thyrotropin and thyroid cancer diagnosis:a systematic review and dose-response meta-analysis. J Clin Endocrinol Metab, 2012, 97(8):2682-2692.
17.	Cooper DS. TSH suppressive therapy:an overview of long-term clinical Consequences. Hormones (Athens), 2010, 9(1):57-59.
18.	De Oliveira Chachamovitz DS, Dos Santos Vigário P, Nogueira Cordeiro MF, et al. Quality of life, muscle strength, and fatigue perception in patients on suppressive therapy with levothyroxine for differentiated thyroid carcinoma. Am J Clin Oncol, 2013, 36(4):354-361.
19.	Negro R, Valcavi R, Toulis KA. Incidental thyroid cancer in toxic and nontoxic goiter:Is TSH associated with malignancy rate? Results of a meta-analysis. Endocr Pract, 2013, 19(2):212-218.
20.	楊衛平, 何永剛, 蔡偉耀, 等. 結節性甲狀腺腫術后甲狀腺激素水平的變化及其對抑制治療的意義. 外科理論與實踐, 1999, 4(4):211-214.
21.	邢蘭蘭, 陳松, 李亞明. 分化型甲狀腺癌促甲狀腺激素抑制治療的現狀及進展. 中華臨床醫師雜志:電子版, 2012, 6(20):6455-6457.
22.	趙詠桔. 分化型甲狀腺癌的個體化TSH抑制治療:雙風險評估治療目標. 外科理論與實踐, 2014, 19(3):208-213.
23.	徐校成, 王可敬. 分化型甲狀腺癌術后應用促甲狀腺激素抑制療法的價值探討. 中華全科醫學, 2015, 13(5):740-742.
24.	閆慧嫻, 谷偉軍, 呂朝暉. 血清促甲狀腺激素與甲狀腺癌的關系. 國際內分泌代謝雜志, 2013, 33(5):318-320.

1. ?趙琳, 李志劍. 北京市人群健康及相關生活方式的調查報告. 中西醫結合心腦血管病雜志, 2014, 12(8):1021-1022.
2. 中華醫學會內分泌學分會, 中華醫學會外科學分會內分泌學組, 中國抗癌協會頭頸腫瘤專業委員會, 等. 甲狀腺結節和分化型甲狀腺癌診治指南. 中華內分泌代謝雜志, 2012, 28(10):779-797.
3. 黃韜. 分化型甲狀腺癌的規范治療. 中國普外基礎與臨床雜志, 2012, 19(8):805-808.
4. 馬峻峰, 唐波, 李鐵漢, 等. 促甲狀腺激素抑制療法在分化型甲狀腺癌治療中的作用. 中國普外基礎與臨床雜志, 2009, 16(5):348-350, 355.
5. 閆慧賢, 呂朝暉. 分化型甲狀腺癌TSH抑制治療的雙風險評估. 藥品評價, 2014, 11(3):34-37.
6. 王松, 張方潔, 代文杰, 等. 分化型甲狀腺癌術后的TSH抑制治療. 中華普通外科雜志, 2014, 29(4):295-298.
7. 屈丹, 姜雅秋. 急性低血糖大鼠血清 FT3、FT4、TSH 水平及下丘腦組織 TRH 表達變化. 山東醫藥, 2015, 55(31):30-32.
8. 費成英. 血清TT3、FT3、TT4、FT4以及TSH檢測意義. 國際檢驗醫學雜志, 2010, 31(2):121-122.
9. Diessl S, Holzberger B, M?der U, et al. Impact of moderate vs stringent TSH suppression on survival in advanced differentiated thyroid carcinoma. Clin Endocrinol (Oxf), 2012, 76(4):586-592.
10. Tuttle R, Ball D, Byrd D, et al. NCCN clinical practice guidelines in oncology (NCCN Guidelines^{^?}):Thyroid carcinoma version 2.2012. Fort Washington (PA):National Comprehensive Cancer Network, 2012.
11. 蘇艷軍, 楊婷婷, 張建明, 等. 甲狀腺術后的甲狀腺功能維護. 國際外科學雜志, 2014, 41(2):114-119.
12. Gudmundsson J, Sulem P, Gudbjartsson DF, et al. Discovery of common variants associated with low TSH levels and thyroid cancer risk. Nat Genet, 2012, 44(3):319-322.
13. Fiore E, Vitti P. Serum TSH and risk of papillary thyroid cancer in nodular thyroid disease. J Clin Endocrinol Metab, 2012, 97(4):1134-1145.
14. Sherman SI. Targeted therapies for thyroid tumors. Mod Pathol, 2011, 24(Suppl 2):S44-S52.
15. 白耀, 連小蘭. 分化型甲狀腺癌患者需要個體化的TSH抑制. 中華內分泌代謝雜志, 2011, 27(6):451-453.
16. McLeod DS, Watters KF, Carpenter AD, et al. Thyrotropin and thyroid cancer diagnosis:a systematic review and dose-response meta-analysis. J Clin Endocrinol Metab, 2012, 97(8):2682-2692.
17. Cooper DS. TSH suppressive therapy:an overview of long-term clinical Consequences. Hormones (Athens), 2010, 9(1):57-59.
18. De Oliveira Chachamovitz DS, Dos Santos Vigário P, Nogueira Cordeiro MF, et al. Quality of life, muscle strength, and fatigue perception in patients on suppressive therapy with levothyroxine for differentiated thyroid carcinoma. Am J Clin Oncol, 2013, 36(4):354-361.
19. Negro R, Valcavi R, Toulis KA. Incidental thyroid cancer in toxic and nontoxic goiter:Is TSH associated with malignancy rate? Results of a meta-analysis. Endocr Pract, 2013, 19(2):212-218.
20. 楊衛平, 何永剛, 蔡偉耀, 等. 結節性甲狀腺腫術后甲狀腺激素水平的變化及其對抑制治療的意義. 外科理論與實踐, 1999, 4(4):211-214.
21. 邢蘭蘭, 陳松, 李亞明. 分化型甲狀腺癌促甲狀腺激素抑制治療的現狀及進展. 中華臨床醫師雜志:電子版, 2012, 6(20):6455-6457.
22. 趙詠桔. 分化型甲狀腺癌的個體化TSH抑制治療:雙風險評估治療目標. 外科理論與實踐, 2014, 19(3):208-213.
23. 徐校成, 王可敬. 分化型甲狀腺癌術后應用促甲狀腺激素抑制療法的價值探討. 中華全科醫學, 2015, 13(5):740-742.
24. 閆慧嫻, 谷偉軍, 呂朝暉. 血清促甲狀腺激素與甲狀腺癌的關系. 國際內分泌代謝雜志, 2013, 33(5):318-320.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Selection of Thyrotropin Suppression Therapeutic Timing in Postoperative Patients with Differentiated Thyroid Carcinoma

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