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.	鄭向前, 楊偉偉, 王會娟, 等. 分化型甲狀腺癌診療進展. 中華普通外科雜志, 2019, 34(3): 273-276.
2.	中國抗癌協會甲狀腺癌專業委員會(CATO). 甲狀腺微小乳頭狀癌診斷與治療中國專家共識(2016版). 中國腫瘤雜志, 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.
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6.	中華醫學會內分泌學分會, 中華醫學會外科學分會內分泌學組, 中國抗癌協會頭頸腫瘤專業委員會, 等. 甲狀腺結節和分化型甲狀腺癌診治指南. 中國腫瘤臨床, 2012, 39(17): 1249-1272.
7.	朱精強, 雷建勇. 甲狀腺微小乳頭狀癌過度治療與不足. 中國實用外科雜志, 2016, 36(5): 520-523.
8.	關海霞. 甲狀腺微小癌術后促甲狀腺激素抑制治療認識和挑戰. 中國實用外科雜志, 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.	羅娟章, 王偉, 孫傳政. 女性甲狀腺癌患者術后促甲狀腺激素抑制治療及其對經期的影響. 國際耳鼻咽喉頭頸外科雜志, 2017, 41(3): 171-174.
13.	許軍, 李朋, 肖光雄, 等. 分化型甲狀腺癌術后促甲狀腺激素抑制治療時機的選擇. 中國普外基礎與臨床雜志, 2016, 23(2): 206-209.
14.	謝強. 甲狀腺癌術后相關激素水平的變化及意義. 中國現代普通外科進展, 2016, 19(1): 28-31.
15.	王志宏, 張浩, 張平, 等. 甲狀腺腺葉切除術后血清促甲狀腺激素變化的臨床研究. 中華內分泌代謝雜志, 2017, 33(11): 955-958.
16.	許健, 章遠江, 金科, 等. 不同年齡患者甲狀腺腺葉切除術后甲狀腺功能變化的研究. 中國普通外科雜志, 2014, 23(5): 653-656.

1. 鄭向前, 楊偉偉, 王會娟, 等. 分化型甲狀腺癌診療進展. 中華普通外科雜志, 2019, 34(3): 273-276.
2. 中國抗癌協會甲狀腺癌專業委員會(CATO). 甲狀腺微小乳頭狀癌診斷與治療中國專家共識(2016版). 中國腫瘤雜志, 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. 中華醫學會內分泌學分會, 中華醫學會外科學分會內分泌學組, 中國抗癌協會頭頸腫瘤專業委員會, 等. 甲狀腺結節和分化型甲狀腺癌診治指南. 中國腫瘤臨床, 2012, 39(17): 1249-1272.
7. 朱精強, 雷建勇. 甲狀腺微小乳頭狀癌過度治療與不足. 中國實用外科雜志, 2016, 36(5): 520-523.
8. 關海霞. 甲狀腺微小癌術后促甲狀腺激素抑制治療認識和挑戰. 中國實用外科雜志, 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. 羅娟章, 王偉, 孫傳政. 女性甲狀腺癌患者術后促甲狀腺激素抑制治療及其對經期的影響. 國際耳鼻咽喉頭頸外科雜志, 2017, 41(3): 171-174.
13. 許軍, 李朋, 肖光雄, 等. 分化型甲狀腺癌術后促甲狀腺激素抑制治療時機的選擇. 中國普外基礎與臨床雜志, 2016, 23(2): 206-209.
14. 謝強. 甲狀腺癌術后相關激素水平的變化及意義. 中國現代普通外科進展, 2016, 19(1): 28-31.
15. 王志宏, 張浩, 張平, 等. 甲狀腺腺葉切除術后血清促甲狀腺激素變化的臨床研究. 中華內分泌代謝雜志, 2017, 33(11): 955-958.
16. 許健, 章遠江, 金科, 等. 不同年齡患者甲狀腺腺葉切除術后甲狀腺功能變化的研究. 中國普通外科雜志, 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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