Department of Otorhinolaryngology-Head and Neck Surgery, Korea Cancer Center Hospital, Seoul, Korea.
Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
Endocrinol Metab (Seoul). 2019 Jun;34(2):150-157. doi: 10.3803/EnM.2019.34.2.150. Epub 2019 Mar 19.
Thyroid-stimulating hormone (TSH) suppression is recommended for patients who undergo thyroidectomy for differentiated thyroid cancer (DTC). However, the impact of TSH suppression on clinical outcomes in low-risk DTC remains uncertain. Therefore, we investigated the effects of postoperative TSH levels on recurrence in patients with low-risk DTC after thyroid lobectomy.
Patients (=1,528) who underwent thyroid lobectomy for papillary thyroid carcinoma between 2000 and 2012 were included in this study. According to the mean and dominant TSH values during the entire follow-up period or 5 years, patients were divided into four groups (<0.5, 0.5 to 1.9, 2.0 to 4.4, and ≥4.5 mIU/L). Recurrence-free survival was compared among the groups.
During the 5.6 years of follow-up, 21 patients (1.4%) experienced recurrence. Mean TSH levels were within the recommended low-normal range (0.5 to 1.9 mIU/L) during the total follow-up period or 5 years in 38.1% or 36.0% of patients. The mean and dominant TSH values did not affect recurrence-free survival. Adjustment for other risk factors did not alter the results.
Serum TSH levels did not affect short-term recurrence in patients with low-risk DTC after thyroid lobectomy. TSH suppression should be conducted more selectively.
对于因分化型甲状腺癌（DTC）而接受甲状腺切除术的患者，推荐进行促甲状腺激素（TSH）抑制。然而，TSH 抑制对低危 DTC 患者的临床结局的影响仍不确定。因此，我们研究了甲状腺叶切除术后低危 DTC 患者术后 TSH 水平对复发的影响。
本研究纳入了 2000 年至 2012 年间因乳头状甲状腺癌而接受甲状腺叶切除术的患者（n=1528）。根据整个随访期间或 5 年内的平均和主导 TSH 值，将患者分为四组（<0.5、0.5 至 1.9、2.0 至 4.4 和≥4.5 mIU/L）。比较各组的无复发生存率。
在 5.6 年的随访期间，21 例患者（1.4%）发生复发。在整个随访期间或 5 年内，38.1%或 36.0%的患者的平均 TSH 水平处于推荐的低正常范围内（0.5 至 1.9 mIU/L）。平均和主导 TSH 值不影响无复发生存率。调整其他危险因素并未改变结果。
甲状腺叶切除术后低危 DTC 患者的血清 TSH 水平不影响短期复发。TSH 抑制应更具选择性。
