Pujol P, Daures J P, Nsakala N, Baldet L, Bringer J, Jaffiol C
Department of Endocrinology, University Hospital of Montpellier, France.
J Clin Endocrinol Metab. 1996 Dec;81(12):4318-23. doi: 10.1210/jcem.81.12.8954034.
We investigate whether the prognosis of patients with differentiated thyroid cancer is improved by maintaining a greater level of TSH suppression. One hundred and forty-one patients who underwent hormone therapy after thyroidectomy were followed up from 1970 to 1993 (mean, 95 months). Patients received levothyroxine (L-T4; mean dose, 2.6 micrograms/kg-day). TSH suppression was evaluated by TRH stimulation test until 1986 and thereafter by a second generation immunoradiometric assay. As TSH underwent fluctuation over time in most patients, we focused on subgroups of patients with relatively constant TSH levels during the follow-up. The relapse-free survival (RFS) was longer in the group with constantly suppressed TSH (all TSH values, < or = 0.05 mU/L; n = 18) than in the group with nonsuppressed TSH (all TSH values, > or = 1 mU/L; n = 15; P < 0.01). Age, sex, tumor node metastasis stage, and initial therapy were not different between the suppressed and nonsuppressed TSH groups. In the overall population, we analyzed the level of TSH suppression by studying the percentage of undetectable TSH values (< or = 0.05 mU/L) during the follow-up. The patients with a greater degree of TSH suppression (> 90% of undetectable TSH values; n = 19) had a trend toward a longer RFS than the remaining population (n = 102; P = 0.14). The patients with a lesser degree of TSH suppression (< 10% of undetectable TSH values; n = 27) had a shorter RFS than the remaining patients (n = 94; P < 0.01). In multivariate analysis that included TSH suppression, age, sex, histology, and tumor node metastasis stage, the degree of TSH suppression predicted RFS independently of other factors (P = 0.02). This study shows that a lesser degree of TSH suppression is associated with an increased incidence of relapse, supporting the hypothesis that a high level of TSH suppression is required for the endocrine management of thyroid cancer.
我们研究了通过维持更高水平的促甲状腺激素（TSH）抑制是否能改善分化型甲状腺癌患者的预后。141例甲状腺切除术后接受激素治疗的患者于1970年至1993年接受随访（平均95个月）。患者接受左甲状腺素（L-T4；平均剂量，2.6微克/千克·天）治疗。1986年前通过促甲状腺激素释放激素（TRH）刺激试验评估TSH抑制情况，此后通过第二代免疫放射分析进行评估。由于大多数患者的TSH随时间波动，我们重点关注随访期间TSH水平相对稳定的患者亚组。持续抑制TSH的组（所有TSH值≤0.05 mU/L；n = 18）的无复发生存期（RFS）比未抑制TSH的组（所有TSH值≥1 mU/L；n = 15；P < 0.01）更长。TSH抑制组和未抑制组在年龄、性别、肿瘤淋巴结转移分期和初始治疗方面无差异。在总体人群中，我们通过研究随访期间不可检测的TSH值（≤0.05 mU/L）的百分比来分析TSH抑制水平。TSH抑制程度较高（不可检测的TSH值> 90%；n = 19）的患者的RFS有长于其余人群（n = 102；P = 0.14）的趋势。TSH抑制程度较低（不可检测的TSH值< 10%；n = 27）的患者的RFS短于其余患者（n = 94；P < 0.01）。在包括TSH抑制、年龄、性别、组织学和肿瘤淋巴结转移分期的多变量分析中，TSH抑制程度独立于其他因素预测RFS（P = 0.02）。本研究表明，较低程度的TSH抑制与复发发生率增加相关，支持了甲状腺癌内分泌管理需要高水平TSH抑制的假说。
