Nagayama Yuji, Tachibana Seigo, Fukuda Takashi, Katsuyama Kento, Tatsushima Daisuke, Mori Yusuke, Shindo Hisakazu, Takahashi Hiroshi, Okamura Misa, Yamaoka Atsushi, Sato Shinya, Yamashita Hiroyuki
Department of Endocrinology, Yamashita Thyroid Hospital, Fukuoka 812-0034, Japan.
Department of Surgery, Yamashita Thyroid Hospital, Fukuoka 812-0034, Japan.
Endocr J. 2025 Mar 27. doi: 10.1507/endocrj.EJ25-0009.
No evidence-based standards exist regarding levothyroxine (LT4) replacement therapy initiation timing in patients with hyperthyroid Graves' disease undergoing total thyroidectomy. Although LT4 replacement from the first postoperative day has been the standard of care at our hospital, its clinical validity has not been thoroughly examined. This study investigated the perioperative kinetics of thyroid hormones to assess the safety and efficacy of early LT4 initiation. Thirty patients with Graves' disease (18 hyperthyroid and 12 euthyroid) and 12 with thyroid nodules who underwent total thyroidectomy were included. Blood samples were collected from each patient for thyroid hormone measurement on the day before surgery (D-1), 15 min after surgery (D0), at 8:00 am on days 1 (D1) and 3 (D3), and 3 weeks (W3) and 3 months (M3) after surgery. In 18 patients with hyperthyroid Graves' disease, serum free triiodothyronine (FT3) levels significantly decreased immediately after surgery and were within the normal range by D1. Although LT4 was started on D1, FT3 levels continued to decline by D3 and remained low at W3 and M3. Serum FT4 levels followed a slower decline but remained within the normal range for M3. In patients with euthyroid Graves' disease and those with thyroid nodules, hormone levels stayed within or around the reference range throughout the observation period. In conclusion, initiating LT4 on the day after surgery is safe and effective for maintaining thyroid function in patients with hyperthyroid Graves' disease undergoing total thyroidectomy. These results could inform future guidelines, supporting earlier postoperative LT4 initiation.
对于接受全甲状腺切除术的甲状腺功能亢进型格雷夫斯病患者，在左甲状腺素（LT4）替代治疗起始时机方面不存在基于证据的标准。尽管从术后第一天开始进行LT4替代一直是我院的护理标准，但其临床有效性尚未得到充分检验。本研究调查了甲状腺激素的围手术期动力学，以评估早期开始使用LT4的安全性和有效性。纳入了30例格雷夫斯病患者（18例甲状腺功能亢进和12例甲状腺功能正常）以及12例接受全甲状腺切除术的甲状腺结节患者。在手术前一天（D-1）、手术后15分钟（D0）、术后第1天（D1）和第3天（D3）上午8:00以及术后3周（W3）和3个月（M3）采集每位患者的血样进行甲状腺激素测量。在18例甲状腺功能亢进型格雷夫斯病患者中，术后血清游离三碘甲状腺原氨酸（FT3）水平立即显著下降，到D1时已在正常范围内。尽管在D1开始使用LT4，但FT3水平在D3时继续下降，在W3和M3时仍较低。血清FT4水平下降较慢，但在M3时仍保持在正常范围内。在甲状腺功能正常的格雷夫斯病患者和甲状腺结节患者中，整个观察期内激素水平保持在参考范围内或接近参考范围。总之，对于接受全甲状腺切除术的甲状腺功能亢进型格雷夫斯病患者，术后第一天开始使用LT4对维持甲状腺功能是安全有效的。这些结果可为未来的指南提供参考，支持术后更早开始使用LT4。
