Section of Endocrine Surgery, Department of Surgery, UCLA David Geffen School of Medicine, Los Angeles, California.
Division of Endocrinology, Diabetes, and Metabolism; Department of Medicine, UCLA David Geffen School of Medicine, Los Angeles, California; Division of Endocrinology, Diabetes, and Metabolism; Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, California.
Endocr Pract. 2021 Jul;27(7):691-697. doi: 10.1016/j.eprac.2021.01.004. Epub 2021 Jan 15.
To determine the frequency of levothyroxine (LT4) supplementation after therapeutic lobectomy for low-risk differentiated thyroid cancer (DTC).
This retrospective cohort study enrolled adult patients with low-risk DTC confirmed using surgical pathology who underwent therapeutic lobectomy at a single institution from January 2016 through May 2020. The outcome measures were postoperative serum thyroid-stimulating hormone (TSH) levels and the initiation of LT4. The predictors of a postoperative TSH level of >2 mU/L and initiation of LT4 were evaluated using Cox proportional hazards models.
Postoperative TSH levels were available for 115 patients (91%), of whom 97 (84%) had TSH levels >2 mU/L after thyroid lobectomy. Over a median follow-up of 2.6 years, a postoperative TSH level of >2 mU/L was associated with older age (median 52 vs 37 years; P = .01), higher preoperative TSH level (1.7 vs 0.85 mU/L; P < .001), and primary tumor size of <1 cm (38% vs 11%, P = .03). Multivariate analysis revealed that only preoperative TSH level was an independent predictor of a postoperative TSH level of >2 mU/L (hazard ratio [HR] 1.53, P = .003). Among patients with a postoperative TSH level of >2 mU/L, 66 (68%) were started on LT4 at a median of 74 days (interquartile range 41-126) after lobectomy, with 51 (77%) undergoing at least 1 subsequent dose adjustment to maintain compliance with current guidelines.
More than 80% of the patients who underwent therapeutic lobectomy for DTC developed TSH levels that were elevated beyond the recommended range, and most of these patients were prescribed LT4 soon after the surgery.
确定低危分化型甲状腺癌（DTC）患者接受治疗性甲状腺叶切除术后左旋甲状腺素（LT4）补充的频率。
本回顾性队列研究纳入了 2016 年 1 月至 2020 年 5 月在一家单机构接受治疗性甲状腺叶切除术的低危 DTC 经手术病理证实的成年患者。结局指标为术后血清促甲状腺激素（TSH）水平和 LT4 的起始。使用 Cox 比例风险模型评估术后 TSH 水平>2mU/L 和 LT4 起始的预测因素。
115 例患者（91%）术后 TSH 水平可获得，其中 97 例（84%）甲状腺叶切除术后 TSH 水平>2mU/L。中位随访 2.6 年后，术后 TSH 水平>2mU/L与年龄较大（中位数 52 岁比 37 岁；P=0.01）、术前 TSH 水平较高（1.7mU/L 比 0.85mU/L；P<0.001）和原发肿瘤直径<1cm（38%比 11%，P=0.03）相关。多变量分析显示，只有术前 TSH 水平是术后 TSH 水平>2mU/L的独立预测因素（风险比[HR]1.53，P=0.003）。在术后 TSH 水平>2mU/L的患者中，66 例（68%）在甲状腺叶切除术后中位 74 天（四分位距 41-126）开始服用 LT4，其中 51 例（77%）至少进行了 1 次后续剂量调整以维持符合现行指南。
超过 80%的接受治疗性甲状腺叶切除的 DTC 患者的 TSH 水平升高至推荐范围以上，且这些患者中的大多数在手术后不久就开始服用 LT4。
