2015 年美国甲状腺协会指南与甲状腺叶切除术后促甲状腺激素抑制治疗
2015 American Thyroid Association guidelines and thyroid-stimulating hormone suppression after thyroid lobectomy.
机构信息
Department of Otolaryngology - Head and Neck Surgery, University of Virginia Health System, Charlottesville, Virginia, USA.
School of Medicine, University of Virginia, Charlottesville, Virginia, USA.
出版信息
Head Neck. 2021 Feb;43(2):639-644. doi: 10.1002/hed.26524. Epub 2020 Oct 30.
BACKGROUND
2015 American Thyroid Association (ATA) guidelines recommended more conservative treatment in low-risk well-differentiated thyroid cancer (WDTC), stating that lobectomy alone may be sufficient. The guidelines further recommend mild thyroid-stimulating hormone (TSH) level suppression (0.5-2 mU/L) for this population. Our goal is to evaluate the natural history of patients undergoing lobectomy to determine the percentage that would require postoperative levothyroxine supplementation under these guidelines.
METHODS
Retrospective chart review of 168 patients that underwent lobectomy between 2010 and 2019 was performed. Preoperative and postoperative TSH values and the rate of patients prescribed levothyroxine were analyzed.
RESULTS
Thirty-five percent of patients were prescribed levothyroxine postoperatively. At 6 weeks postoperatively, 66% had TSH value of >2; this increased to 76% by 6 to 12 months.
CONCLUSION
To adhere to ATA guidelines for WDTC managed with lobectomy alone, the majority of patients (76%) would require postoperative levothyroxine supplementation. Low preoperative TSH was found to be the most significant predictor for postoperative TSH < 2.
背景
2015 年美国甲状腺协会（ATA）指南建议对低危分化型甲状腺癌（WDTC）采用更保守的治疗方法，指出单纯腺叶切除术可能就足够了。该指南还建议对这部分人群进行轻度甲状腺刺激素（TSH）水平抑制（0.5-2mU/L）。我们的目标是评估行腺叶切除术患者的自然病程，以确定在这些指南下有多少患者需要术后补充左甲状腺素。
方法
对 2010 年至 2019 年间行腺叶切除术的 168 例患者进行回顾性图表审查。分析了术前和术后 TSH 值以及开处左甲状腺素的患者比例。
结果
术后 35%的患者需要服用左甲状腺素。术后 6 周时，66%的患者 TSH 值>2；6-12 个月时，这一比例增至 76%。
结论
为了遵守 ATA 关于单纯行腺叶切除术治疗 WDTC 的指南，大多数患者（76%）需要术后补充左甲状腺素。研究发现，术前 TSH 水平较低是术后 TSH<2 的最显著预测因素。
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