全喉切除术后甲状腺功能减退症的发病：甲状腺手术及术前、术后放疗的影响。
Onset of hypothyroidism after total laryngectomy: Effects of thyroid gland surgery and preoperative and postoperative radiotherapy.
机构信息
Department of Otorhinolaryngology, Head and Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Department of Otorhinolaryngology, Head and Neck Surgery, Medical Center Leeuwarden, Leeuwarden, The Netherlands.
出版信息
Head Neck. 2020 Apr;42(4):636-644. doi: 10.1002/hed.26048. Epub 2019 Dec 13.
BACKGROUND
To determine time of onset and risk of hypothyroidism after total laryngectomy (TL) with and without (hemi)thyroidectomy in relation to treatment regimen, that is, preoperative radiotherapy (RT-TL), postoperative radiotherapy (TL-RT), and postoperative re-irradiation (RT-TL-RT).
METHODS
Retrospective review of 128 patients treated by RT-TL (51 patients), TL-RT (55 patients), and RT-TL-RT (22 patients). Risk of hypothyroidism was determined by multivariable Cox regression analysis and euthyroid survival was calculated using Kaplan-Meier method.
RESULTS
Hypothyroidism developed in 69 (54%) patients. The median onset of hypothyroidism was later (P < .01) and the risk of hypothyroidism was lower (hazard ratio 0.49; P = .014) in the TL-RT group compared to both other treatment regimens. Euthyroid survival did not differ between the treatment regimens. Two years euthyroid survival was 24% with and 61% without (hemi)thyroidectomy (P < .001).
CONCLUSIONS
Patients treated with TL-RT have later onset of hypothyroidism. Higher risk for hypothyroidism is associated with salvage TL after radiotherapy and (hemi)thyroidectomy.
背景
为了确定全喉切除术（TL）伴或不伴（半）甲状腺切除术与治疗方案（术前放疗[RT-TL]、术后放疗[TL-RT]和术后再放疗[RT-TL-RT]）相关的甲状腺功能减退症发病时间和风险。
方法
回顾性分析了 128 例接受 RT-TL（51 例）、TL-RT（55 例）和 RT-TL-RT（22 例）治疗的患者。采用多变量 Cox 回归分析确定甲状腺功能减退症的风险，并采用 Kaplan-Meier 法计算甲状腺功能正常的生存情况。
结果
69 例（54%）患者发生甲状腺功能减退症。与其他两种治疗方案相比，TL-RT 组甲状腺功能减退症的发病时间较晚（P<0.01），且甲状腺功能减退症的风险较低（风险比 0.49；P=0.014）。治疗方案之间的甲状腺功能正常生存情况无差异。2 年甲状腺功能正常生存率为 24%和 61%（有或无（半）甲状腺切除术）（P<0.001）。
结论
接受 TL-RT 治疗的患者甲状腺功能减退症的发病时间较晚。甲状腺功能减退症的风险更高与放疗后挽救性 TL 和（半）甲状腺切除术相关。
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