Endocrinology Department, Recep Tayyip Erdoğan University, Rize, Turkey.
Psychiatrics Department, Recep Tayyip Erdoğan University, Rize, Turkey.
Horm Metab Res. 2021 Oct;53(10):683-691. doi: 10.1055/a-1639-1024. Epub 2021 Oct 4.
In differentiated thyroid cancer (DTC), the standard treatment includes total thyroidectomy and lifetime levothyroxine (LT4) replacement. However, long-term exogenous LT4 has become controversial due to the adverse effects of oversuppression. The study included 191 patients (aged 18-76 years) with a prospective diagnosis of non-metastatic DTC and 79 healthy individuals. The patients with DTC were stratified into three groups according to their TSH levels: suppressed thyrotropin if TSH was below 0.1 μIU/ml, mildly suppressed thyrotropin if TSH was between 0.11 and 0.49 μIU/ml, and low-normal thyrotropin if THS was between 0.5 and 2 μIU/ml. The Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Anxiety Sensitivity Index (ASI), Short Symptom Inventory (SSI), and Pittsburgh Sleep Quality Index (PSQI) were administered to all participants. It was found that the BDI, BAI, SSI and PSQI scores were worse in patients with DTC (p=0.024, p=0.014, p=0.012, and p=0.001, respectively). According to theTSH levels, the mean ASI was found to be higher in the suppressed and mildly suppressed thyrotropin groups (19±14.4 vs. 10.6±11.1; 16.4±14.9 vs. 10.6±11.1, p=0.024, respectively), the mean SSI was found higher in the suppressed group (61.0±55.5 vs. 35.1±37.0, p=0.046), and the mean PSQI was higher in all three groups (7.94±3.97 vs. 5.35±4.13; 7.21±4.59 vs. 5.35±4.13; 7.13±4.62 vs. 5.35±4.13, p=0.006) when compared with the controls. No significant difference was found between the groups. A positive correlation was detected in the duration of LT4 use and BDI and SSI, and a weak, negative correlation was detected between TSH levels and ASI and PSQI. Based on our study, it was found that depression, anxiety disorders, and sleep problems were more prevalent in patients with DTC, being more prominent in the suppressed TSH group. These results were inversely correlated with TSH values and positively correlated with the duration of LT4 use. Unnecessary LT4 oversuppression should be avoided in patients with DTC.
在分化型甲状腺癌（DTC）中，标准治疗包括甲状腺全切除术和终身左旋甲状腺素（LT4）替代治疗。然而，由于过度抑制的不良反应，长期外源性 LT4 已成为争议的焦点。该研究纳入了 191 例（年龄 18-76 岁）前瞻性诊断为非转移性 DTC 的患者和 79 例健康个体。根据 TSH 水平，将 DTC 患者分为三组：TSH＜0.1μIU/ml 为抑制性甲状腺素，0.11＜TSH＜0.49μIU/ml 为轻度抑制性甲状腺素，0.5＜TSH＜2μIU/ml 为低正常甲状腺素。所有参与者均接受贝克抑郁量表（BDI）、贝克焦虑量表（BAI）、焦虑敏感指数（ASI）、简明症状量表（SSI）和匹兹堡睡眠质量指数（PSQI）评估。结果发现，DTC 患者的 BDI、BAI、SSI 和 PSQI 评分较差（p=0.024、p=0.014、p=0.012 和 p=0.001）。根据 TSH 水平，抑制性和轻度抑制性甲状腺素组的平均 ASI 较高（19±14.4 与 10.6±11.1；16.4±14.9 与 10.6±11.1，p=0.024），抑制性甲状腺素组的平均 SSI 较高（61.0±55.5 与 35.1±37.0，p=0.046），所有三组的平均 PSQI 均较高（7.94±3.97 与 5.35±4.13；7.21±4.59 与 5.35±4.13；7.13±4.62 与 5.35±4.13，p=0.006），与对照组相比。组间无显著差异。LT4 使用时间与 BDI 和 SSI 呈正相关，与 ASI 和 PSQI 呈弱负相关。基于我们的研究，发现 DTC 患者中抑郁、焦虑障碍和睡眠问题更为普遍，在抑制性 TSH 组更为明显。这些结果与 TSH 值呈负相关，与 LT4 使用时间呈正相关。DTC 患者应避免不必要的 LT4 过度抑制。
