Center for Excellence in Thyroid Care, Kuma Hospital, Kobe 650-0011, Japan.
Endocr J. 2019 Nov 28;66(11):953-960. doi: 10.1507/endocrj.EJ19-0094. Epub 2019 Jul 2.
Previous reports by us and other investigators showed that among athyreotic patients on levothyroxine (LT) following total thyroidectomy patients with normal serum thyroid-stimulating hormone (TSH) levels had mildly low serum free triiodothyronine (FT) levels, whereas patients with mildly suppressed serum TSH levels had normal serum FT levels and patients with strongly suppressed serum TSH had elevated serum FT levels. The objective of this study was to clarify which of these three patient groups are closer to their preoperative euthyroid condition based on reported subjective symptoms. We prospectively studied 148 consecutive euthyroid patients with papillary thyroid carcinoma who underwent a total thyroidectomy. Symptoms reflecting thyroid function documented preoperatively and following 12 months of LT after thyroidectomy were compared. In 65 patients with strongly suppressed TSH levels significant changes in symptoms with tendencies towards thyrotoxicosis were seen with regards to heat and cold tolerance (p < 0.01), bowel movements (p < 0.05), and hand tremors (p < 0.05). In 33 patients with normal TSH levels, significant changes in symptoms with tendencies towards hypothyroidism were seen with regards to heat and cold tolerance (p < 0.05) and activity (p < 0.05). Lastly, in 50 patients with mildly suppressed TSH levels and FT levels equivalent to preoperative levels, all symptom items remained equivalent to their preoperative levels. Symptoms reflecting thyroid function in patients on LT following total thyroidectomy suggested that patients with mildly suppressed TSH levels were closest to a euthyroid status. These data provide useful findings regarding the management of patients following total thyroidectomy.
我们和其他研究人员之前的报告表明，在接受全甲状腺切除术并服用左甲状腺素（LT）的无甲状腺患者中，血清甲状腺刺激激素（TSH）水平正常的患者血清游离三碘甲状腺原氨酸（FT）水平略低，而血清 TSH 水平轻度抑制的患者血清 FT 水平正常，血清 TSH 水平强烈抑制的患者血清 FT 水平升高。本研究的目的是根据报告的主观症状阐明这三组患者中哪一组更接近术前的甲状腺功能正常状态。我们前瞻性研究了 148 例连续的甲状腺乳头状癌患者，这些患者均接受了全甲状腺切除术。比较了术前和术后 12 个月 LT 治疗后反映甲状腺功能的症状。在 65 例 TSH 水平强烈抑制的患者中，热耐量和冷耐量（p < 0.01）、肠蠕动（p < 0.05）和手震颤（p < 0.05）方面的症状出现显著变化，且有甲亢倾向。在 33 例 TSH 水平正常的患者中，热耐量和冷耐量（p < 0.05）和活动（p < 0.05）方面的症状出现显著变化，有甲减倾向。最后，在 50 例 TSH 水平轻度抑制且 FT 水平与术前水平相当的患者中，所有症状均与术前水平相当。LT 治疗后的全甲状腺切除术后患者的甲状腺功能相关症状表明，TSH 水平轻度抑制的患者最接近甲状腺功能正常状态。这些数据为全甲状腺切除术后患者的管理提供了有用的发现。
