Department of Otolaryngology/Head and Neck Surgery, VU University Medical Center, Amsterdam, The Netherlands.
Department of Clinical Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands.
Oral Oncol. 2013 Sep;49(9):950-955. doi: 10.1016/j.oraloncology.2013.03.450. Epub 2013 Apr 17.
The incidences of hypo(para)thyroidism were assessed prospectively in 137 consecutive patients with laryngeal (84.7%) or hypopharyngeal (15.3%) carcinoma who were treated with surgery and/or radiotherapy between 2004 and 2006.
Laboratory studies were performed in patients before primary or salvage treatment of a laryngeal or hypopharyngeal carcinoma and were repeated 6, 12, 18 and 24months after treatment. All patients were evaluated for the development of hypo(para)thyroidism, and the presence of autoantibodies. The association of hypothyroidism was analyzed against several patient parameters including tumor and treatment characteristics.
The incidence of hypothyroidism following treatment of laryngeal and hypopharyngeal carcinoma was 47.4%: 27.7% subclinical hypothyroidism and 19.7% clinical hypothyroidism. The median time to develop hypothyroidism was 10months. The incidence of hypoparathyroidism was 7.3%. Univariate analysis showed that patients with laryngectomy, hemithyroidectomy, neck dissection, paratracheal lymph node dissection and radiotherapy had a higher risk of developing hypothyroidism. Multivariate analysis showed laryngectomy, hemithyroidectomy, neck dissection and age to be predictive factors for the development of hypothyroidism. The combination of surgery and radiotherapy increased this risk. Hemithyroidectomy was the most important risk factor.
The incidence rate of hypothyroidism after treatment for laryngeal or hypopharyngeal cancer in this largest prospective study is high (47.4%), especially after combination treatment. Based on the intervals between treatment and the development of hypothyroidism, thyroid testing before treatment, every 3months during the first year, every 6months the second year and annually thereafter is recommended as screening procedure.
前瞻性评估 2004 年至 2006 年间接受手术和/或放疗的 137 例喉（84.7%）或下咽（15.3%）癌连续患者的亚临床和临床甲状腺功能减退症发生率。
对 137 例接受喉或下咽癌初始或挽救性治疗的患者进行实验室研究，分别在治疗前、治疗后 6、12、18 和 24 个月进行重复检查。所有患者均评估甲状腺功能减退症的发生情况及自身抗体的存在情况。分析甲状腺功能减退症与包括肿瘤和治疗特征在内的多种患者参数之间的关联。
喉和下咽癌治疗后甲状腺功能减退症的发生率为 47.4%：亚临床甲状腺功能减退症 27.7%，临床甲状腺功能减退症 19.7%。发生甲状腺功能减退症的中位时间为 10 个月。甲状旁腺功能减退症的发生率为 7.3%。单因素分析显示行喉切除术、甲状腺叶切除术、颈清扫术、气管旁淋巴结清扫术和放疗的患者发生甲状腺功能减退症的风险更高。多因素分析显示喉切除术、甲状腺叶切除术、颈清扫术和年龄是发生甲状腺功能减退症的预测因素。手术和放疗的联合增加了这种风险。甲状腺叶切除术是最重要的危险因素。
本最大前瞻性研究中，喉或下咽癌治疗后甲状腺功能减退症的发生率较高（47.4%），尤其是联合治疗后。根据治疗与甲状腺功能减退症发生之间的时间间隔，建议在治疗前进行甲状腺功能检查，治疗后第 1 年每 3 个月检查 1 次，第 2 年每 6 个月检查 1 次，之后每年检查 1 次。
