Objective To explore the efficacy and safety of levothyroxine (L-T4) combined with desiccated thyroid extract (DTE) in patients with differentiated thyroid cancer (DTC) who had suboptimal response to long-term (≥6 months) thyroid-stimulating hormone (TSH) suppression therapy with L-T4 alone after surgery. MethodsA total of 123 eligible patients were prospectively enrolled and received TSH suppression therapy with DTE combined with L-T4. The Kaplan?Meier (KM) curve was used to analyze the TSH suppression rate and assess the efficacy of this combination therapy. The Thyroid-Related Patient-Reported Outcome-39 (THyPRO-39) questionnaire was used to assess the patient-reported symptoms before medication adjustment and at 1, 3, 6, 9, and 12 months after adjustment. ResultsAmong the 123 patients, 100 were ultimately included and completed follow-up, with a follow-up period of one year. After the first adjustment to L-T4+DTE combination therapy, the rate of TSH suppression was raised to 71.0% (71/100). The KM curve revealed that the TSH suppression rate gradually increased during the follow-up period, with a cumulative rate of 82.0%. The median TSH suppression time to reach the standard was 1.4 months. Eighteen patients (18.0%) still did not meet the target after multiple regimen adjustments. Univariate analysis indicated that sex and pre-treatment serum free triiodothyronine (FT3) levels were associated with the attainment rate of TSH suppression therapy (P<0.05). However, multivariate logistic regression analysis revealed that neither sex (OR=0.353, P=0.148) nor pre-treatment serum FT3 level (OR=2.596, P=0.101) was an independent influencing factor of TSH suppression attainment rate. Following L-T4+DTE combination therapy, the serum FT3 level significantly increased [(4.5±0.6) pmol/L vs. (5.5±1.1) pmol/L, P<0.001] but remained within the normal range, whereas the free thyroxine (FT4) level did not significantly change [(21.9±2.1) pmol/L vs. (21.5±3.0) pmol/L, P=0.075]. However, patients who did not achieve target levels exhibited a decrease in serum FT4 levels compared to baseline, and the magnitude of this decrease was significantly greater than that observed in the target-achieved group [–0.8 (–2.1, –0.9) pmol/L vs. –2.5 (–3.8, –0.8) pmol/L, P=0.022]. The questionnaire results indicated that the combined L-T4+DTE treatment regimen had no significant impact on overall quality of life scores during the follow-up period (χ2=4.006, P=0.548). Conversely, the hyperthyroidism symptom scores showed significant improvement over the treatment period (χ2=23.120, P<0.001), with the median scores demonstrating an overall downward trend. ConclusionFor postoperative DTC patients who fail to achieve TSH suppression with L-T4 monotherapy, L-T4+DTE combination therapy can significantly increase the TSH suppression attainment rate while alleviating thyrotoxicosis-related symptoms.
Objective To systematically assess the correlation between smoking and the risk of endometriosis, so as to offer scientific basis to health education and preventing decision. Methods A literature search was performed in The Cochrane Library, Pubmed, Embase, CBM, CNKI and Wanfang database to collect the case control studies on the correlation between smoking and endometriosis. Two reviewers independently screened the literatures according to the inclusion and exclusion criteria, extracted the data, assessed the quality, and then conducted Meta-analyses on the 13 included RCTs by using RevMan 5.0 software, with calculation of the OR value and 95%CI. Results A total of 13 case control studies involving 14260 cases were included, of which 1900 ones were endometriosis. The quality assessment indicated that 2 studies were in quality of Level A, 4 were Level B, 7 were Level C, totally meant low quality. Meta-analyses showed that compared with non-smokers, there was no increasing possibility of endometriosis in smokers (OR= 0.91, 95%CI 0.82 to 1.02). The geographical subgroup analyses showed there was no significant difference in the incidence of endometriosis between the non-smokers and smokers in North America (OR=0.96, 95%CI 0.84 to 1.08), but a significant difference was found between non-smokers and smokers in Europe (OR=0.72, 95%CI 0.54 to 0.97). Conclusion There is no causative relationship between smoking and incidence of endometriosis. However, more high-quality trials are expected for further study because of the heterogeneity and poor quality of the current included studies.
