Sakr Mahmoud, Mahmoud Ahmed
Department of Surgery, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
Clin Exp Otorhinolaryngol. 2017 Dec;10(4):289-295. doi: 10.21053/ceo.2016.01578. Epub 2017 May 24.
Total thyroidectomy is increasingly accepted for the management of bilateral benign thyroid disorders. Postoperatively, patients require lifelong levothyroxine replacement therapy to avoid postoperative hypothyroidism, which besides the burden of compliance, has been proven to be associated with several long-term side effects. Heterotopic thyroid autotransplantation was proposed several decades ago to avoid the need for life-long postoperative replacement therapy with maintaining the autoregulatory mechanism of thyroxin production inside the body according to its needs. Available data regarding this topic in literature is relatively poor. Before applying thyroid autotransplantation on humans, several studies have been done on animals, where the autologous transplantations were found to be successful in almost all the cases, proved by follow up postoperative 8-week measurements of thyroid hormones and histopathological examination of the removed autografts. Regarding the clinical application, few trials have been done using cryopreserved in vivo, in vitro or immediately autotransplanted thyroid autografts. Satisfactory results were obtained, however, the number of these studies and the number of patients per each study was very low. Besides the study methodologies were not so consistent.
全甲状腺切除术在双侧良性甲状腺疾病的治疗中越来越被广泛接受。术后,患者需要终身服用左甲状腺素替代疗法以避免术后甲状腺功能减退,这除了带来依从性负担外,还被证明与多种长期副作用有关。几十年前就有人提出进行异位甲状腺自体移植,以避免终身术后替代治疗的需要,同时保持体内甲状腺素根据自身需求产生的自动调节机制。关于该主题的文献资料相对较少。在将甲状腺自体移植应用于人类之前,已经在动物身上进行了多项研究,通过术后8周甲状腺激素测量以及对切除的自体移植物进行组织病理学检查发现,几乎所有病例的自体移植均取得成功。关于临床应用,使用冷冻保存的体内、体外或立即自体移植的甲状腺自体移植物进行的试验较少。然而,虽然取得了令人满意的结果,但这些研究的数量以及每项研究的患者数量都非常少。此外,研究方法也不太一致。