Department of Surgery, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, People's Republic of China.
Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, People's Republic of China.
BJS Open. 2022 Jul 7;6(4). doi: 10.1093/bjsopen/zrac079.
The relationship between good early control of thyroid hormone levels after thyroidectomy for Graves' disease (GD) and subsequent risks of mortality and morbidities is not well known. The aim of this study was to examine the association between thyroid hormone levels within a short interval after surgery and long-term mortality and morbidity risks from a population-based database.
Patients with GD who underwent complete/total thyroidectomy between 2006 and 2018 were selected from the Hong Kong Hospital Authority clinical management system. All patients were classified into three groups (euthyroidism, hypothyroidism, and hyperthyroidism) according to their thyroid hormone levels at 6, 12, and 24 months after surgery. Cox proportional hazards models were performed to compare the risks of all-cause mortality, cardiovascular disease (CVD), Graves' ophthalmopathy, and cancer.
Over a median follow-up of 68 months with 5709 person-years, 949 patients were included for analysis (euthyroidism, n = 540; hypothyroidism, n = 282; and hyperthyroidism, n = 127). The hypothyroidism group had an increased risk of CVD (HR = 4.20, 95 per cent c.i. 2.37 to 7.44, P < 0.001) and the hyperthyroidism group had an increased risk of cancer (HR = 2.14, 95 per cent c.i. 1.55 to 2.97, P < 0.001) compared with the euthyroidism group. Compared with patients obtaining euthyroidism both at 6 months and 12 months, the risk of cancer increased in patients who achieved euthyroidism at 6 months but had an abnormal thyroid status at 12 months (HR = 2.33, 95 per cent c.i. 1.51 to 3.61, P < 0.001) and in those who had abnormal thyroid status at 6 months but achieved euthyroidism at 12 months (HR = 2.52, 95 per cent c.i. 1.60 to 3.97, P < 0.001).
This study showed a higher risk of CVD in postsurgical hypothyroidism and a higher risk of cancer in hyperthyroidism compared with achieving euthyroidism early after thyroidectomy. Patients who were euthyroid at 6 months and 12 months had better outcomes than those achieving euthyroidism only at 6 months or 12 months. Attaining biochemical euthyroidism early after thyroidectomy should become a priority.
甲状腺激素水平在 Graves 病（GD）甲状腺切除术后早期得到良好控制与随后的死亡率和发病率风险之间的关系尚不清楚。本研究旨在从基于人群的数据库中检查手术后短时间内甲状腺激素水平与长期死亡率和发病率风险之间的关联。
从香港医院管理局临床管理系统中选择了 2006 年至 2018 年间接受完全/全甲状腺切除术的 GD 患者。根据术后 6、12 和 24 个月时的甲状腺激素水平，所有患者均分为三组（甲状腺功能正常、甲状腺功能减退和甲状腺功能亢进）。采用 Cox 比例风险模型比较全因死亡率、心血管疾病（CVD）、Graves 眼病和癌症的风险。
中位随访 68 个月，随访 5709 人年，共纳入 949 例患者进行分析（甲状腺功能正常组，n=540；甲状腺功能减退组，n=282；甲状腺功能亢进组，n=127）。与甲状腺功能正常组相比，甲状腺功能减退组 CVD 的风险增加（HR=4.20，95%可信区间 2.37 至 7.44，P<0.001），甲状腺功能亢进组癌症的风险增加（HR=2.14，95%可信区间 1.55 至 2.97，P<0.001）。与 6 个月和 12 个月均达到甲状腺功能正常的患者相比，6 个月时达到甲状腺功能正常但 12 个月时甲状腺功能异常的患者癌症风险增加（HR=2.33，95%可信区间 1.51 至 3.61，P<0.001），而 6 个月时甲状腺功能异常但 12 个月时甲状腺功能正常的患者癌症风险也增加（HR=2.52，95%可信区间 1.60 至 3.97，P<0.001）。
与甲状腺切除术后早期达到甲状腺功能正常相比，术后甲状腺功能减退症患者 CVD 风险较高，甲状腺功能亢进症患者癌症风险较高。6 个月和 12 个月时甲状腺功能正常的患者比仅 6 个月或 12 个月时达到甲状腺功能正常的患者预后更好。甲状腺切除术后早期实现生化甲状腺功能正常应成为优先事项。
