Fussey Jonathan Mark, Khan Habib, Ahsan Farhan, Prashant Ravi, Pettit Laura
Department of Otolaryngology, The Shrewsbury and Telford NHS Trust, Telford, UK.
Department of Clinical Oncology, The Deansley Centre, Royal Wolverhampton Hospital, Wolverhampton, UK.
Head Neck. 2017 Dec;39(12):2567-2572. doi: 10.1002/hed.24926. Epub 2017 Sep 27.
In the management of differentiated thyroid carcinoma, surgery with or without postoperative radioiodine, and thyroid-stimulating hormone (TSH) suppression is the standard of care in most patients. Levothyroxine is recommended for long-term TSH suppression. For some patients, this may be difficult to tolerate due to adverse effects, such as impaired cognitive function.
This article reviews the evidence for the role of combination treatment with triiodothyronine (T3) and levothyroxine (T4) in these patients.
The evidence for combination T3 and T4 treatment comes mainly from studies on hypothyroidism, and research into its use for TSH suppression is limited.
Although the evidence base is not strong, there is a small group of patients who may benefit from combination T3 and T4 treatment due to difficulty tolerating thyroxine. Until further evidence is available, a case-by-case approach is recommended.
在分化型甲状腺癌的治疗中，无论是否进行术后放射性碘治疗以及促甲状腺激素（TSH）抑制治疗，手术都是大多数患者的标准治疗方法。推荐使用左甲状腺素进行长期TSH抑制治疗。对于一些患者来说，由于认知功能受损等不良反应，可能难以耐受。
本文综述了三碘甲状腺原氨酸（T3）和左甲状腺素（T4）联合治疗在这些患者中的作用的证据。
T3和T4联合治疗的证据主要来自于对甲状腺功能减退症的研究，而其用于TSH抑制治疗的研究有限。
尽管证据基础并不充分，但有一小部分患者可能因难以耐受甲状腺素而从T3和T4联合治疗中获益。在获得进一步证据之前，建议采用个案处理的方法。
