Department of General Surgery, Affiliated Hospital of Inner Mongolia Medical University, Hohhot, 010050, Inner Mongolia Autonomous Region, China.
Departments of Neurology, Affiliated Hospital of Inner Mongolia Medical University, Hohhot, 010050, Inner Mongolia Autonomous Region, China.
Endocrine. 2019 Aug;65(2):327-337. doi: 10.1007/s12020-019-01943-8. Epub 2019 May 5.
Thyroid stimulating hormone (TSH) suppression therapy after differentiated thyroid carcinoma surgery causes cognitive impairment. However, data on naming difficulties (anomia)-related specific cognitive impairment are lacking.
A prospective cohort study was conducted, in which, patients with differentiated thyroid carcinoma and benign thyroid nodules were given oral L-T4 therapy after surgery, after meeting the criteria of TSH suppression therapy and thyroxine replacement therapy, respectively, the patients were continually given L-T4 therapy for 6 and 12 months, and then, the neuropsychological test was performed.
Of the 255 subjects, 212 cases (83.13%) completed all the tests, including 33 cases in the normal control group (NC group), 110 cases in the TSH suppression therapy group (TS group), and 69 cases in the thyroxine replacement therapy group (TR group). There was no significant difference in background data among the three groups (P > 0.05). The scores of mini-mental state examination, clock drawing test, digit symbol substitution test, personal history, temporal and spatial orientation, digit order relation, visual object recognition, associative learning, and color naming in the TS and TR groups were not significantly different from those in the NC group after 6 and 12 months of L-T4 therapy (P > 0.05); the scores of picture recall, visual recall, comprehension memory, and digit span forward in the TS and TR groups were notably lower than those in the NC group (P < 0.01); the scores of confrontation naming and listing the names in the TS group were significantly lower than those in the NC and TR groups, and the scores decreased with the prolongation of TSH suppression therapy (P < 0.01).
TSH suppression therapy after differentiated thyroid carcinoma surgery could lead to short-term memory impairment, attention impairment, word selection anomia, and depression, of which, word selection anomia was aggravated with the prolongation of TSH suppression therapy. Therefore, we suggested that optimal TSH goals for individual patients must balance the potential benefit of TSH suppression therapy with the possible harm from subclinical hyperthyroidism especially in low risk differentiated thyroid carcinoma patients (ClinicalTrials.gov Protocol Registration System: ClinicalTrials.gov ID NCT0266532, Registered on 21 June 2016).
分化型甲状腺癌手术后甲状腺刺激激素（TSH）抑制治疗会导致认知障碍。然而，缺乏与命名困难（失名症）相关的特定认知障碍的数据。
进行了一项前瞻性队列研究，其中，分化型甲状腺癌和良性甲状腺结节患者分别在手术后接受口服 L-T4 治疗，分别符合 TSH 抑制治疗和甲状腺素替代治疗标准后，患者连续接受 L-T4 治疗 6 个月和 12 个月，然后进行神经心理学测试。
255 例患者中，212 例（83.13%）完成了所有测试，包括正常对照组（NC 组）33 例，TSH 抑制治疗组（TS 组）110 例，甲状腺素替代治疗组（TR 组）69 例。三组背景资料无显著性差异（P>0.05）。在 L-T4 治疗 6 个月和 12 个月后，TS 和 TR 组的简易精神状态检查、画钟试验、数字符号替代试验、个人史、时空定向、数字顺序关系、视觉物体识别、联想学习和颜色命名评分与 NC 组无显著性差异（P>0.05）；TS 和 TR 组的图片回忆、视觉回忆、理解记忆和数字跨度前向评分明显低于 NC 组（P<0.01）；TS 组的命名性命名和列举名评分明显低于 NC 和 TR 组，且随着 TSH 抑制治疗的延长而降低（P<0.01）。
分化型甲状腺癌手术后 TSH 抑制治疗可导致短期记忆障碍、注意力障碍、选词失名症和抑郁，其中选词失名症随着 TSH 抑制治疗的延长而加重。因此，我们建议，对于个体患者，最佳 TSH 目标必须平衡 TSH 抑制治疗的潜在益处与亚临床甲状腺功能亢进可能带来的危害，特别是在低危分化型甲状腺癌患者中（ClinicalTrials.gov 方案注册系统：ClinicalTrials.gov ID NCT0266532，注册于 2016 年 6 月 21 日）。
