Department of Nuclear Medicine, Tianjin Medical University General Hospital, Tianjin, China.
Department of Otolaryngology Head and Neck Surgery, Tianjin Fourth Central Hospital, Tianjin, China.
Front Endocrinol (Lausanne). 2021 Jun 11;12:601960. doi: 10.3389/fendo.2021.601960. eCollection 2021.
To study the influences of pre-ablation TSH stimulation level, sTg and sTg/TSH ratio on the therapeutic effect of the first I treatment in DTCs.
According to the thyroid stimulating hormone (TSH) levels (mU/l), all the 479 differentiated thyroid cancer (DTC) patients were divided into two groups: TSH < 30 and TSH ≥ 30. The TSH ≥ 30 group was divided into three subgroups: 30 ≤ TSH < 60, 60 ≤ TSH < 90 and TSH ≥ 90. The clinical features and the therapeutic effects of the first I treatment were analyzed. The cutoffs of stimulated thyroglobulin (sTg) and sTg/TSH ratio were calculated to predict the therapeutic effect of I treatment.
Among the three subgroups, the TSH ≥ 90 subgroup was younger and less likely to be associated with cervical lymph node metastasis (LNM). The postoperative levothyroxine (L-T) dose in the 60 ≤ TSH < 90 subgroup was the lowest. Between the two groups, patients in the TSH < 30 group had higher postoperative L-T dose and longer thyroid hormone withdrawal (THW) time. The excellent response rates six months after the first I treatment among the three subgroups and between the two groups were not of statistical significance. The distribution of different TSH stimulation levels among each response group was similar. The cutoffs for the better therapeutic effect of the first I treatment in sTg and sTg/TSH were < 9.51 ng/ml and < 0.11, respectively. Both univariate and multivariate logistic regressions showed that cervical LNM, distant metastasis, higher sTg and higher sTg/TSH ratio predicted poorer therapeutic effect.
There was no significant influence of TSH stimulation levels before the first I treatment on the therapeutic effect of DTC. The sTg/TSH ratio can be considered as another predictor of I therapeutic effect.
研究首次碘治疗前 TSH 刺激水平、sTg 和 sTg/TSH 比值对 DTC 患者治疗效果的影响。
根据甲状腺刺激素（TSH）水平（mU/L），将 479 例分化型甲状腺癌（DTC）患者分为两组：TSH<30 和 TSH≥30。TSH≥30 组再分为三组：30≤TSH<60、60≤TSH<90 和 TSH≥90。分析首次碘治疗的临床特征和疗效。计算刺激甲状腺球蛋白（sTg）和 sTg/TSH 比值的截断值以预测碘治疗的疗效。
在三组中，TSH≥90 组更年轻，且更不易发生颈部淋巴结转移（LNM）。60≤TSH<90 组术后左旋甲状腺素（L-T）剂量最低。两组间，TSH<30 组术后 L-T 剂量更高，甲状腺激素停药（THW）时间更长。三组及两组间首次碘治疗后 6 个月的完全缓解率无统计学意义。不同 TSH 刺激水平在每个反应组中的分布相似。sTg 和 sTg/TSH 较好的治疗效果的截断值分别为<9.51ng/ml 和<0.11。单因素和多因素逻辑回归均显示，颈部 LNM、远处转移、较高的 sTg 和较高的 sTg/TSH 比值预示着较差的治疗效果。
首次碘治疗前 TSH 刺激水平对 DTC 的治疗效果无显著影响。sTg/TSH 比值可作为碘治疗效果的另一个预测指标。
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