格雷夫斯病甲亢患者甲状腺切除术的早期时机可改善生化恢复情况。

Early Timing of Thyroidectomy for Hyperthyroidism in Graves' Disease Improves Biochemical Recovery.

作者信息

Vital Domenic, Morand Grégoire B, Meerwein Christian, Laske Roman D, Steinert Hans C, Schmid Christoph, Brown Michelle L, Huber Gerhard F

机构信息

Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich and University of Zurich, Frauenklinikstrasse 24, 8091, Zurich, Switzerland.

Department of Nuclear Medicine, University Hospital Zurich and University of Zurich, Raemistasse 100, 8091, Zurich, Switzerland.

出版信息

World J Surg. 2017 Oct;41(10):2545-2550. doi: 10.1007/s00268-017-4052-1.

DOI:10.1007/s00268-017-4052-1

PMID:28681142

Abstract

BACKGROUND

The role of thyroidectomy as an early treatment for hyperthyroidism has been poorly investigated. Our aim was to examine its success rates, particularly focusing on thyroidectomy as an early treatment.

METHODS

Patients with thyroidectomy for hyperthyroidism between February 2008 and October 2014 were included. They were divided into two groups (early and delayed thyroidectomy), and patient characteristics, treatment indications, complications and time to biochemical recovery were analyzed.

RESULTS

Ninety-nine patients met the inclusion criteria, of whom 65 (66%) suffered from Graves' disease, 25 (25%) from toxic goiters and 9 (9%) from amiodarone-induced hyperthyroidism. Structural abnormalities of the thyroid (39 patients, 39%) represented the most frequent indications for thyroidectomy. Forty-six patients (46%) underwent an early and 53 (54%) a delayed surgical approach. Patients with Graves' disease undergoing early thyroidectomy did not suffer more often from complications but had a significantly faster biochemical recovery after surgery than those with a delayed thyroidectomy, as judged by a shorter time to reach TSH (121 ± 24 vs. 240 ± 31 days, p = 0.007) and fT4 (91 ± 29 vs. 183 ± 31 days p = 0.015) levels in the normal range. As expected, there were no recurrences of hyperthyroidism.

CONCLUSIONS

Early thyroidectomy was neither associated with permanent complications nor thyroid storm, but with a significantly improved biochemical recovery and therefore has to be recommended early in patients with Graves' disease.

摘要

背景

甲状腺切除术作为甲亢早期治疗手段的作用尚未得到充分研究。我们的目的是研究其成功率，尤其关注甲状腺切除术作为早期治疗的情况。

方法

纳入2008年2月至2014年10月期间因甲亢接受甲状腺切除术的患者。将他们分为两组（早期和延迟甲状腺切除术），并分析患者特征、治疗指征、并发症及生化指标恢复时间。

结果

99例患者符合纳入标准，其中65例（66%）患有格雷夫斯病，25例（25%）患有毒性甲状腺肿，9例（9%）患有胺碘酮所致甲亢。甲状腺结构异常（39例患者，39%）是甲状腺切除术最常见的指征。46例患者（46%）接受了早期手术，53例（54%）接受了延迟手术。接受早期甲状腺切除术的格雷夫斯病患者并发症发生率并不更高，但术后生化指标恢复明显更快，从达到促甲状腺激素（TSH）正常范围的时间较短（121±24天对240±31天，p = 0.007）以及游离甲状腺素（fT4）（91±29天对183±31天，p = 0.015）可判断。正如预期，甲亢无复发情况。