Jonklaas Jacqueline
Division of Endocrinology, Georgetown University, Washington, District of Columbia, USA.
Curr Opin Oncol. 2016 Jan;28(1):18-25. doi: 10.1097/CCO.0000000000000242.
Differentiated thyroid cancer is a malignancy that is rapidly increasing in frequency. As thyroidectomy plays a central role in the treatment of thyroid cancer, it is incumbent on physicians treating this patient group to be well versed in the intricacies of treating hypothyroidism.
Treatment of hypothyroidism may be refined by careful attention to dose selection, monitoring of therapy and achievement of thyrotropin goals that are specific to the individual patient's overall clinical situation. These goals are common not only to patients with a sole diagnosis of hypothyroidism, as discussed in the recent American Thyroid Association Guidelines, but also to patients with hypothyroidism in the setting of thyroid cancer. Several recent studies have illuminated our understanding of the benefits and risks of thyrotropin suppression therapy in patients with differentiated thyroid cancer. Multiple studies of combination therapy with levothyroxine and liothyronine for treating hypothyroidism have not led to a clear conclusion about its benefits over levothyroxine monotherapy. Animal studies have advanced our understanding of the altered serum and tissue milieu that characterizes levothyroxine monotherapy. Crossing the bridge from this translational research into clinical research using sustained release triiodothyronine preparations may ultimately enhance the health of our patients.
Continued refinement of our understanding of thyroid status and our ability to flawlessly implement thyroid hormone replacement is an active area of research.
分化型甲状腺癌是一种发病率迅速上升的恶性肿瘤。由于甲状腺切除术在甲状腺癌治疗中起着核心作用，治疗该患者群体的医生有责任精通治疗甲状腺功能减退症的复杂细节。
通过仔细关注剂量选择、监测治疗以及实现针对个体患者整体临床情况的促甲状腺激素目标，可以优化甲状腺功能减退症的治疗。这些目标不仅适用于单纯诊断为甲状腺功能减退症的患者（如美国甲状腺协会最近的指南中所讨论的），也适用于甲状腺癌患者中的甲状腺功能减退症患者。最近的几项研究阐明了我们对分化型甲状腺癌患者促甲状腺激素抑制治疗的益处和风险的理解。多项关于左甲状腺素和碘塞罗宁联合治疗甲状腺功能减退症的研究尚未就其相对于左甲状腺素单药治疗的益处得出明确结论。动物研究增进了我们对左甲状腺素单药治疗所特有的血清和组织环境改变的理解。从这种转化研究过渡到使用缓释三碘甲状腺原氨酸制剂的临床研究，最终可能会改善我们患者的健康状况。
持续完善我们对甲状腺状态的理解以及完美实施甲状腺激素替代治疗的能力是一个活跃的研究领域。
