Davis James R, Dackiw Alan P, Holt Shelby A, Nwariaku Fiemu E, Oltmann Sarah C
Division of Endocrine Surgery, Department of Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., E6.104B, Dallas, TX, 75390-9092, USA.
World J Surg. 2019 Mar;43(3):812-817. doi: 10.1007/s00268-018-4864-7.
Time to hormonal control after definitive management of hyperthyroidism is unknown but may influence patient and physician decision making when choosing between treatment options. The hypothesis is that the euthyroid state is achieved faster after thyroidectomy than RAI ablation.
A retrospective review of all patients undergoing definitive therapy for hyperthyroidism was performed. Outcomes after thyroidectomy were compared to RAI.
Over 3 years, 217 patients underwent definitive therapy for hyperthyroidism at a county hospital: 121 patients received RAI, and 96 patients underwent thyroidectomy. Age was equivalent (p = 0.72). More males underwent RAI (25% vs 15%, p = 0.05). Endocrinologists referred for both treatments equally (p = 0.82). Both treatments were offered after a minimum 1-year trial of medical management (p = 0.15). RAI patients mostly had Graves (93%), versus 73% of thyroidectomy patients (p < 0.001). Thyroidectomy patients more frequently had eye symptoms (35% vs 13%, p < 0.001), compressive symptoms (74% vs 15%, p < 0.001), or were pregnant/nursing (14% vs 0, p < 0.001). While the thyroidectomy patients had a documented discussion of all treatment modalities, 79% of RAI patients did not have a documented discussion regarding the option of surgical management (p < 0.001). Both treatment groups achieved an euthyroid state (71% vs 65%, p = 0.39). Thyroidectomy patients became euthyroid faster [3 months (2-7 months) versus 9 months (4-14 months); p < 0.001].
Thyroidectomy for hyperthyroidism renders a patient to an euthyroid state faster than RAI. This finding may be important for patients and clinicians considering definitive options for hyperthyroidism.
甲亢最终治疗后达到激素控制的时间尚不清楚，但在选择治疗方案时可能会影响患者和医生的决策。假设是甲状腺切除术后比放射性碘（RAI）消融能更快达到甲状腺功能正常状态。
对所有接受甲亢确定性治疗的患者进行回顾性研究。将甲状腺切除术后的结果与RAI治疗的结果进行比较。
在3年多的时间里，一家县医院有217例患者接受了甲亢的确定性治疗：121例患者接受了RAI治疗，96例患者接受了甲状腺切除术。年龄相当（p = 0.72）。接受RAI治疗的男性更多（25%对15%，p = 0.05）。内分泌科医生对两种治疗的转诊情况相同（p = 0.82）。两种治疗都是在至少1年的药物治疗试验后提供的（p = 0.15）。接受RAI治疗的患者大多患有格雷夫斯病（93%），而接受甲状腺切除术的患者为73%（p < 0.001）。甲状腺切除术患者更常出现眼部症状（35%对13%，p < 0.001）、压迫症状（74%对15%，p < 0.001）或怀孕/哺乳（14%对0，p < 0.001）。虽然甲状腺切除术患者对所有治疗方式都进行了记录在案的讨论，但79%的RAI患者没有关于手术治疗选择的记录在案的讨论（p < 0.001）。两个治疗组均达到甲状腺功能正常状态（71%对65%，p = 0.39）。甲状腺切除术患者达到甲状腺功能正常状态的速度更快[3个月（2 - 7个月）对9个月（4 - 14个月）；p < 0.001]。
甲亢患者接受甲状腺切除术后比接受RAI治疗能更快达到甲状腺功能正常状态。这一发现可能对考虑甲亢确定性治疗方案的患者和临床医生很重要。
