Clinical study on timing of thyroid stimulating hormone inhibition therapy after unilateral thyroid lobectomy in patients with low-risk papillary thyroid microcarcinoma_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LIU Jun ,  WU Hongwei , SUN Shaohua , SHEN Feng , ZHOU Wenbo

Department of Breast and Thyroid Surgery, Dongfeng Hospital Affiliated to Hubei Medical College, Shiyan, Hubei 442008, P. R. China;

Corresponding author：

WU Hongwei, Email: kmwuhongwei@126.com

Keywords：

papillary thyroid microcarcinoma; lobectomy; thyroid stimulating hormone inhibition therapy

DOI：

10.7507/1007-9424.202008021

Video：

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Objective To explore the best timing of thyroid stimulating hormone (TSH) inhibition therapy by analyzing the trend of TSH level changes after unilateral thyroid lobectomy in patients with low-risk papillary thyroid microcarcinoma (PTMC).Methods The clinical data of patients with low-risk PTMC who underwent unilateral thyroid lobectomy in the Dongfeng Hospital Affiliated to Hubei Medical College from September 2016 to December 2018 were retrospectively analyzed. The TSH of all patients were measured before operation and in month 1, 3, and 6 after operation, respectively, and the change trend was analyzed.Results According to the inclusion and exclusion criteria, a total of 271 patients with low-risk PTMC were included in this study. The TSH level in month 1 after operation was higher than that of before operation [(2.93±1.09) mU/L versus (2.05±0.76) mU/L, t=19.9, P<0.001]. Among the 129 patients with TSHlevel ≤2.0 mU/L before operation, 56.6% (73/129) of them still had the TSH level ≤2.0 mU/L in month 1 after operation, 45.0% (58/129) in month 3 after operation and 39.5% (51/129) in month 6 after operation.Conclusions TSH level of patient with low-risk PTMC is increased after lobectomy, so individualized TSH inhibition treatment should be formulated. For patients with TSH level>2.0 mU/L before operation, oral levothyroxine sodium tablets should be taken immediately after operation. For patients with preoperative TSH level ≤2.0 mU/L, TSH level should be dynamically monitored, and whether and when to start oral TSH inhibition therapy should be decided according to results of TSH level.

Citation： LIU Jun, WU Hongwei, SUN Shaohua, SHEN Feng, ZHOU Wenbo. Clinical study on timing of thyroid stimulating hormone inhibition therapy after unilateral thyroid lobectomy in patients with low-risk papillary thyroid microcarcinoma. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2021, 28(5): 645-648. doi: 10.7507/1007-9424.202008021 Copy

1.	郑向前, 杨伟伟, 王会娟, 等. 分化型甲状腺癌诊疗进展. 中华普通外科杂志, 2019, 34(3): 273-276.
2.	中国抗癌协会甲状腺癌专业委员会(CATO). 甲状腺微小乳头状癌诊断与治疗中国专家共识(2016版). 中国肿瘤杂志, 2016, 43(10): 405-411.
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5.	Haugen BR, Alexander EK, Bible KC, et al. 2015 American Thyroid Association Management Guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: The American Thyroid Association Guidelines Task Force on thyroid nodules and differentiated thyroid cancer. Thyroid, 2016, 26(1): 1-133.
6.	中华医学会内分泌学分会, 中华医学会外科学分会内分泌学组, 中国抗癌协会头颈肿瘤专业委员会, 等. 甲状腺结节和分化型甲状腺癌诊治指南. 中国肿瘤临床, 2012, 39(17): 1249-1272.
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8.	关海霞. 甲状腺微小癌术后促甲状腺激素抑制治疗认识和挑战. 中国实用外科杂志, 2016, 36(5): 524-527.
9.	Do Cao C, Wémeau JL. Risk-benefit ratio for TSH-suppressive levothyroxine therapy in differentiated thyroid cancer. Ann Endocrinol (Paris), 2015, 76(1 Suppl 1): S47-S52.
10.	Mazzaferri EL, Jhiang SM. Long-term impact of initial surgical and medical therapy on papillary and follicular thyroid cancer. Am J Med, 1994, 97(5): 418-428.
11.	Wang LY, Smith AW, Palmer FL, et al. Thyrotropin suppression increases the risk of osteoporosis without decreasing recurrence in ATA low- and intermediate-risk patients with differentiated thyroid carcinoma. Thyroid, 2015, 25(3): 300-307.
12.	罗娟章, 王伟, 孙传政. 女性甲状腺癌患者术后促甲状腺激素抑制治疗及其对经期的影响. 国际耳鼻咽喉头颈外科杂志, 2017, 41(3): 171-174.
13.	许军, 李朋, 肖光雄, 等. 分化型甲状腺癌术后促甲状腺激素抑制治疗时机的选择. 中国普外基础与临床杂志, 2016, 23(2): 206-209.
14.	谢强. 甲状腺癌术后相关激素水平的变化及意义. 中国现代普通外科进展, 2016, 19(1): 28-31.
15.	王志宏, 张浩, 张平, 等. 甲状腺腺叶切除术后血清促甲状腺激素变化的临床研究. 中华内分泌代谢杂志, 2017, 33(11): 955-958.
16.	许健, 章远江, 金科, 等. 不同年龄患者甲状腺腺叶切除术后甲状腺功能变化的研究. 中国普通外科杂志, 2014, 23(5): 653-656.

1. 郑向前, 杨伟伟, 王会娟, 等. 分化型甲状腺癌诊疗进展. 中华普通外科杂志, 2019, 34(3): 273-276.
2. 中国抗癌协会甲状腺癌专业委员会(CATO). 甲状腺微小乳头状癌诊断与治疗中国专家共识(2016版). 中国肿瘤杂志, 2016, 43(10): 405-411.
3. Mehanna H, Al-Maqbili T, Carter B, et al. Differences in the recurrence and mortality outcomes rates of incidental and nonincidental papillary thyroid microcarcinoma: a systematic review and meta-analysis of 21 329 person-years of follow-up. J Clin Endocrinol Metab, 2014, 99(8): 2834-2843.
4. Miyauchi A. Clinical trials of active surveillance of papillary microcarcinoma of the thyroid. World J Surg, 2016, 40(3): 516-522.
5. Haugen BR, Alexander EK, Bible KC, et al. 2015 American Thyroid Association Management Guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: The American Thyroid Association Guidelines Task Force on thyroid nodules and differentiated thyroid cancer. Thyroid, 2016, 26(1): 1-133.
6. 中华医学会内分泌学分会, 中华医学会外科学分会内分泌学组, 中国抗癌协会头颈肿瘤专业委员会, 等. 甲状腺结节和分化型甲状腺癌诊治指南. 中国肿瘤临床, 2012, 39(17): 1249-1272.
7. 朱精强, 雷建勇. 甲状腺微小乳头状癌过度治疗与不足. 中国实用外科杂志, 2016, 36(5): 520-523.
8. 关海霞. 甲状腺微小癌术后促甲状腺激素抑制治疗认识和挑战. 中国实用外科杂志, 2016, 36(5): 524-527.
9. Do Cao C, Wémeau JL. Risk-benefit ratio for TSH-suppressive levothyroxine therapy in differentiated thyroid cancer. Ann Endocrinol (Paris), 2015, 76(1 Suppl 1): S47-S52.
10. Mazzaferri EL, Jhiang SM. Long-term impact of initial surgical and medical therapy on papillary and follicular thyroid cancer. Am J Med, 1994, 97(5): 418-428.
11. Wang LY, Smith AW, Palmer FL, et al. Thyrotropin suppression increases the risk of osteoporosis without decreasing recurrence in ATA low- and intermediate-risk patients with differentiated thyroid carcinoma. Thyroid, 2015, 25(3): 300-307.
12. 罗娟章, 王伟, 孙传政. 女性甲状腺癌患者术后促甲状腺激素抑制治疗及其对经期的影响. 国际耳鼻咽喉头颈外科杂志, 2017, 41(3): 171-174.
13. 许军, 李朋, 肖光雄, 等. 分化型甲状腺癌术后促甲状腺激素抑制治疗时机的选择. 中国普外基础与临床杂志, 2016, 23(2): 206-209.
14. 谢强. 甲状腺癌术后相关激素水平的变化及意义. 中国现代普通外科进展, 2016, 19(1): 28-31.
15. 王志宏, 张浩, 张平, 等. 甲状腺腺叶切除术后血清促甲状腺激素变化的临床研究. 中华内分泌代谢杂志, 2017, 33(11): 955-958.
16. 许健, 章远江, 金科, 等. 不同年龄患者甲状腺腺叶切除术后甲状腺功能变化的研究. 中国普通外科杂志, 2014, 23(5): 653-656.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Clinical study on timing of thyroid stimulating hormone inhibition therapy after unilateral thyroid lobectomy in patients with low-risk papillary thyroid microcarcinoma

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