Wang Zhihong, Angell Trevor E, Sun Wei, Qin Yuan, He Liang, Dong Wenwu, Zhang Dalin, Zhang Ting, Shao Liang, Lv Chengzhou, Zhang Ping, Guan Haixia, Zhang Hao
Department of Thyroid Surgery, the First Hospital of China Medical University, Shenyang, China.
Division of Endocrinology, Diabetes and Metabolism, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
Ann Transl Med. 2020 Oct;8(19):1238. doi: 10.21037/atm-20-4890.
Thyrotropin (TSH) suppression is a critical step in the management of differentiated thyroid carcinoma (DTC). The objectives of this study were to evaluate changes in TSH levels and a strategy of initial levothyroxine (LT4) supplementation for TSH suppression in low-risk differentiated thyroid carcinoma (lr-DTC) patients after lobectomy.
One hundred and ten patients with lr-DTC who received lobectomy were enrolled. Each of the patients was given 50 µg LT4 immediately after lobectomy and were retrospectively analyzed to evaluate the initial dose of LT4 suppression during the first year of follow-up. Risk factors influencing the TSH trend were also evaluated.
Median TSH levels decreased significantly after lobectomy and the initiation of LT4 suppression and were stable from 3 to 12 months. Three months after lobectomy, 44.9% of patients fell into the newly recommended first TSH goal (0.35 to 2.0 mIU/L). Insufficient suppression (≥2.0 mIU/L) and oversuppression (<0.35 mIU/L) was observed in 9.4% and 45.8% of the patients, respectively. Preoperative TSH ≥2.0 mIU/L and the coexistence of Hashimoto thyroiditis (HT) were risk factors influencing the TSH trend.
The monitoring of TSH could start from 3 months after lobectomy. An initial dose (50 µg) of LT4 could be adequate for initial suppression therapy in most patients. However, individual adjustment of the first dose may be necessary based on preoperative TSH concentration and the presence of HT.
促甲状腺激素（TSH）抑制是分化型甲状腺癌（DTC）管理中的关键步骤。本研究的目的是评估低风险分化型甲状腺癌（lr-DTC）患者肺叶切除术后TSH水平的变化以及初始左甲状腺素（LT4）补充用于TSH抑制的策略。
纳入110例行肺叶切除术的lr-DTC患者。每位患者在肺叶切除术后立即给予50μg LT4，并进行回顾性分析，以评估随访第一年期间LT4抑制的初始剂量。还评估了影响TSH趋势的危险因素。
肺叶切除术后及开始LT4抑制后，TSH水平中位数显著下降，并在3至12个月保持稳定。肺叶切除术后3个月，44.9%的患者达到新推荐的首个TSH目标（0.35至2.0 mIU/L）。分别有9.4%和45.8%的患者出现抑制不足（≥2.0 mIU/L）和抑制过度（<0.35 mIU/L）。术前TSH≥2.0 mIU/L和合并桥本甲状腺炎（HT）是影响TSH趋势的危险因素。
TSH监测可在肺叶切除术后3个月开始。初始剂量（50μg）的LT4对大多数患者的初始抑制治疗可能足够。然而，可能需要根据术前TSH浓度和HT的存在情况对首剂进行个体化调整。
