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.	赵琳, 李志剑. 北京市人群健康及相关生活方式的调查报告. 中西医结合心脑血管病杂志, 2014, 12(8):1021-1022.
2.	中华医学会内分泌学分会, 中华医学会外科学分会内分泌学组, 中国抗癌协会头颈肿瘤专业委员会, 等. 甲状腺结节和分化型甲状腺癌诊治指南. 中华内分泌代谢杂志, 2012, 28(10):779-797.
3.	黄韬. 分化型甲状腺癌的规范治疗. 中国普外基础与临床杂志, 2012, 19(8):805-808.
4.	马峻峰, 唐波, 李铁汉, 等. 促甲状腺激素抑制疗法在分化型甲状腺癌治疗中的作用. 中国普外基础与临床杂志, 2009, 16(5):348-350, 355.
5.	闫慧贤, 吕朝晖. 分化型甲状腺癌TSH抑制治疗的双风险评估. 药品评价, 2014, 11(3):34-37.
6.	王松, 张方洁, 代文杰, 等. 分化型甲状腺癌术后的TSH抑制治疗. 中华普通外科杂志, 2014, 29(4):295-298.
7.	屈丹, 姜雅秋. 急性低血糖大鼠血清 FT3、FT4、TSH 水平及下丘脑组织 TRH 表达变化. 山东医药, 2015, 55(31):30-32.
8.	费成英. 血清TT3、FT3、TT4、FT4以及TSH检测意义. 国际检验医学杂志, 2010, 31(2):121-122.
9.	Diessl S, Holzberger B, Mäder 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.	苏艳军, 杨婷婷, 张建明, 等. 甲状腺术后的甲状腺功能维护. 国际外科学杂志, 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, 连小兰. 分化型甲状腺癌患者需要个体化的TSH抑制. 中华内分泌代谢杂志, 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.	杨卫平, 何永刚, 蔡伟耀, 等. 结节性甲状腺肿术后甲状腺激素水平的变化及其对抑制治疗的意义. 外科理论与实践, 1999, 4(4):211-214.
21.	邢兰兰, 陈松, 李亚明. 分化型甲状腺癌促甲状腺激素抑制治疗的现状及进展. 中华临床医师杂志:电子版, 2012, 6(20):6455-6457.
22.	赵咏桔. 分化型甲状腺癌的个体化TSH抑制治疗:双风险评估治疗目标. 外科理论与实践, 2014, 19(3):208-213.
23.	徐校成, 王可敬. 分化型甲状腺癌术后应用促甲状腺激素抑制疗法的价值探讨. 中华全科医学, 2015, 13(5):740-742.
24.	闫慧娴, 谷伟军, 吕朝晖. 血清促甲状腺激素与甲状腺癌的关系. 国际内分泌代谢杂志, 2013, 33(5):318-320.

1. 赵琳, 李志剑. 北京市人群健康及相关生活方式的调查报告. 中西医结合心脑血管病杂志, 2014, 12(8):1021-1022.
2. 中华医学会内分泌学分会, 中华医学会外科学分会内分泌学组, 中国抗癌协会头颈肿瘤专业委员会, 等. 甲状腺结节和分化型甲状腺癌诊治指南. 中华内分泌代谢杂志, 2012, 28(10):779-797.
3. 黄韬. 分化型甲状腺癌的规范治疗. 中国普外基础与临床杂志, 2012, 19(8):805-808.
4. 马峻峰, 唐波, 李铁汉, 等. 促甲状腺激素抑制疗法在分化型甲状腺癌治疗中的作用. 中国普外基础与临床杂志, 2009, 16(5):348-350, 355.
5. 闫慧贤, 吕朝晖. 分化型甲状腺癌TSH抑制治疗的双风险评估. 药品评价, 2014, 11(3):34-37.
6. 王松, 张方洁, 代文杰, 等. 分化型甲状腺癌术后的TSH抑制治疗. 中华普通外科杂志, 2014, 29(4):295-298.
7. 屈丹, 姜雅秋. 急性低血糖大鼠血清 FT3、FT4、TSH 水平及下丘脑组织 TRH 表达变化. 山东医药, 2015, 55(31):30-32.
8. 费成英. 血清TT3、FT3、TT4、FT4以及TSH检测意义. 国际检验医学杂志, 2010, 31(2):121-122.
9. Diessl S, Holzberger B, Mäder 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. 苏艳军, 杨婷婷, 张建明, 等. 甲状腺术后的甲状腺功能维护. 国际外科学杂志, 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, 连小兰. 分化型甲状腺癌患者需要个体化的TSH抑制. 中华内分泌代谢杂志, 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. 杨卫平, 何永刚, 蔡伟耀, 等. 结节性甲状腺肿术后甲状腺激素水平的变化及其对抑制治疗的意义. 外科理论与实践, 1999, 4(4):211-214.
21. 邢兰兰, 陈松, 李亚明. 分化型甲状腺癌促甲状腺激素抑制治疗的现状及进展. 中华临床医师杂志:电子版, 2012, 6(20):6455-6457.
22. 赵咏桔. 分化型甲状腺癌的个体化TSH抑制治疗:双风险评估治疗目标. 外科理论与实践, 2014, 19(3):208-213.
23. 徐校成, 王可敬. 分化型甲状腺癌术后应用促甲状腺激素抑制疗法的价值探讨. 中华全科医学, 2015, 13(5):740-742.
24. 闫慧娴, 谷伟军, 吕朝晖. 血清促甲状腺激素与甲状腺癌的关系. 国际内分泌代谢杂志, 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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