分化型甲状腺癌患者停用甲状腺素后TSH和FT_4水平的变化  

Change of serum TSH and FT_4 after thyroxine withdrawal in differential thyroid carcinoma

作　　者：陈泽泉[1] 罗全勇[1] 陈立波[1] 丁颖[1] 余永利[1] 陆汉魁[1] 

机构地区：[1]上海交通大学第六人民医院核医学科,上海200233

出　　处：《上海交通大学学报（医学版）》2008年第1期39-41,共3页Journal of Shanghai Jiao tong University:Medical Science

摘　　要：目的定量分析分化型甲状腺癌（DTC）患^131碘治疗前停用甲状腺素制剂（优甲乐）后的TSH和FT4变化，探讨进行^131碘显像和治疗的恰当时间。方法67例DTC患者在接受过甲状腺次全切或全切术以及^131碘清除残留甲状腺治疗后准备再次^131碘治疗，在开始停用优甲乐后每周测量血清中TSH和FT4指标，动态观察两项指标的变化。结幂DTC患者停用优甲乐后，血清TSH逐渐升高，但升高幅度存在个体差异。TSH的升高幅度与FT4的下降幅度呈一定相关性，但无统计学意义（r=-0．945，P=0．055）；女性患者TSH升高速率显著低于男性患者（P=0．001）；老年人血清TSH升高速率显著低于年轻患者（P=0．037）。停药后第1—4周TSH≥30μIU／mL的患者比例分别为7．4％、37．4％、81．9％和91．5％。结论多数DTC患者停用甲状腺激素3周后即可进行^131碘检查和治疗。Objective To observe the change of TSH and FT4 after thyroxine withdrawal in patients with differential thyroid carcinoma（DTC） and determine an appropriate time for radioiodine therapy. Methods Sixty-seven DTC patients with subtotal or total thyroidectomy followed by ^131I ablation were to undergo a second ^131I therapy. Serum TSH and FT4 were measured and changes were dynamically observed every weeks after thyroxine withdrawal. Results After thyroxine withdrawal, serum TSH was gradually increasd with individual variation. The increase of TSH was correlated with the decrease of FT4 to some extent, while no significant difference was observed（ r = -0. 945, P = 0. 055 ）. The increase of TSH was much lower in females than males（P =0. 001 ） , and that was also lower in the aged than the young （P =0. 037）. The percentages of those with TSH ≥ 30 μIU/mL 1 to 4 weeks after thyroxine withdrawal were 7.4% , 37.4% , 81.9% and 91.5%, respectively. Conclusion Most patients with DTC are ready to receive ^131I therapy 3 weeks after thyroxine withdrawal.

关 键 词：甲状腺肿瘤 综合疗法 ^131碘 左旋甲状腺素 

分 类 号：R736.1[医药卫生—肿瘤]