不同剂量促甲状腺激素对分化型甲状腺癌病人术后相关指标的影响

代瑞; 杨枋

doi:10.13898/j.cnki.issn.1000-2200.2018.04.025

不同剂量促甲状腺激素对分化型甲状腺癌病人术后相关指标的影响

代瑞,
杨枋

Effect of different doses of TSH on the postoperative related indicators in patients with differentiated thyroid cancer

DAI Rui,
YANG Fang

摘要

摘要: 目的：探讨不同剂量促甲状腺激素（TSH）对分化型甲状腺癌病人术后相关指标的影响。方法：选取分化型甲状腺癌病人50例作为研究对象，均择期行甲状腺全切除术治疗，术后30 d均采用¹³¹I清除残余甲状腺残留组织，随后给予TSH治疗。根据应用TSH剂量的不同，分为常规剂量组和抑制剂量组，各25例。常规剂量组病人给予左旋甲状腺素钠片2.0 μg/kg；抑制剂量组给予左旋甲状腺素钠片2.5 μg/kg。比较2组病人治疗前和治疗12个月后游离三碘甲状腺原氨酸（FT3）、游离甲状腺素（FT4）、TSH等甲状腺功能指标，血清中钙、磷和碱性磷酸酶水平，以及L_2-4椎体、Ward三角、股骨大转子和股骨干4个部位的骨密度指标。结果：治疗前2组病人FT3、FT4、TSH水平差异均无统计学意义（P>0.05）；与治疗前比较，2组治疗12个月后FT3、FT4水平均明显升高（P<0.01），TSH水平均明显降低（P<0.01），且抑制剂量组FT3、FT4水平均明显高于常规剂量组（P<0.01），TSH水平明显低于常规剂量组（P<0.01）。2组病人治疗前后的血清钙、磷和碱性磷酸酶水平及L_2-4椎体、Ward三角、股骨大转子、股骨干的骨密度差异均无统计学意义（P>0.05）。结论：常规剂量的左旋甲状腺素能够确保分化型甲状腺癌病人术后的正常生理需求，抑制剂量则会使甲状腺功能保持在亚临床甲亢状态，不同剂量的左旋甲状腺素对骨代谢和BMD的影响较小，临床可根据病人实际情况进行剂量选择。

Abstract: Objective:To investigate the effect of different doses of thyroid stimulating hormone(TSH) on the postoperative related indicators in patients with differentiated thyroid cancer.Methods:Fifty differentiated thyroid cancer patients scheduled by operation were investigated.After 30 days of operation,the patients were treated with removing remnant thyroid residual tissue using ¹³¹I combined with TSH therapy.Patients were divided into the conventional dose group and inhibitive dose group according to the different dose of TSH(25 cases each group).The conventional dose group was treated with 2.0 μg/kg L-thyroxine sodium tablet,and the inhibitive dose group was treated with 2.5 μg/kg L-thyroxine sodium tablet.The levels of free triiodothyronine(FT3),serum free thyroxine(FT4),TSH,the serum levels of calcium,phosphorus and alkaline phosphatase (ALP),and the bone mineral density in L_2-4 vertebral body,ward triangle,femoral large rotor and femoral shaft between before and after treatment in two groups were compared.Results:The differences of the levels of FT3,FT4 and TSH between two groups were not statistically significant before treatment(P>0.05).Compared with before treatment,the levels of FT3 and FT4 in two groups significantly increased(P<0.01),the TSH levels in two groups significantly decreased(P<0.01),the levels of FT3 and FT4 in inhibitive dose group were significantly higher than those in conventional dose group(P<0.01),and the levels of TSH in inhibitive dose group were significantly lower than that in conventional dose group after 12 months of treatment(P<0.01).The differences of the levels of calcium,phosphorus and ALP and bone mineral density in L_2-4 vertebral body,ward triangle,femoral large rotor and femoral shaft in two groups between before and after treatment were not statistically significant(P>0.05).Conclusions:The conventional dose of L-thyroxine can ensure the normal physiological needs of patients with differentiated thyroid cancer,and the inhibitive dose can keep thyroid function in subclinical hyperthyroidism.The effect of different doses of L-thyroxine on bone metabolism and bone mineral density is small.The dose is selected on the basis of the actual situation of patients.

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