Study On The Relationship Between TSH Level Before ¹³¹I Ablation And The Responses Of Non-Distant Metastatic Papillary Thyroid Carcinoma

Objective To investigate the relationship between serum thyroid stimulating hormone（TSH）level after thyroid hormone withdrawal before the first ¹³¹I treatment and the response in patients with non-distant metastatic thyroid papillary carcinoma（PTC）;To find out the independent factors of poor prognosis after ¹³¹I ablation in those patients;To observe the incidence of radioactive mumps after ¹3131 I ablation.Methods A retrospective analysis from December 2013 to December 2017 in Anhui Provincial Hospital Affiliated Medical University has been total or near total thyroidectomy with non-distance metastatic PTC patients,included 117 cases for the study.According to the TSH level before radioiodine ablation,the patients were divided intoTSH<30mIU/L,30mIU/L≤TSH<60mIU/L,60mIU/L≤TSH<90mIU/L,TSH≥90mIU/L group.Serum thyroglobulin,thyroglobulin antibody,imaging findings and iodine whole body scan results were stimulated after six months of radioactive iodine ablation.According to the 2015 American Thyroid Association（ATA）guideline,the results were divided into four categories（ER、IDR、BIR、SIR）.Compared the clinical,pathological features and the responses of each group.ER and IDR was classified as a good prognosis,BIR and SIR as a poor prognosis.The prognosis of patients after ¹³¹I ablation was set as the dependent variable,thyroid stimulating hormone level,age,sex,serum thyroglobulin level,residual thyroid tissue mass,number of lesions,presence or absence of capsule invasion,and whether or not Hashimoto’s thyroiditis was combined.The factors were set as independent variables,and the above independent variables were analyzed by univariate analysis,and then the statistically significant variables were subjected to binary logistic regression analysis.Statistical analysis was performed using SPSS 17.0.The data in accordance with the normal distribution were expressed as mean±standard deviation.The data that did not conform to the normal distribution were represented by median and quartile,and the classified data was expressed by frequency.Chi-square test was used to compare the data of the classified data.One-way analysis of variance was used to compare the age of patients between different TSH groups.The post-mortem test used LSD test.K-W test showed whether there was any difference in serum Tg and residual nail quality between the groups.The age difference between the two groups was compared by independent sample t test.The Mann-Whitney U test was used to compare the TSH（ug/L）,Tg（ug/L）and residual nail quality between the two groups.Finally,binary logistic regression was used to analyze independent factors that affected poor prognosis.The analysis of this study was a two-sided test,and a P value of<0.05 was considered statistically significant.Results 117 patients with non-distant metastatic PTC,TSH<30mUI/L group,age48.5±13.6,30mIU/L group≤TSH<60mIU/L group,age 45.0±11.9,60mIU/L group≤TSH<90mIU/L The age of the group was 41.3±11.2,TSH≥90mIU/L,and the age was36.±11.56.The age difference between the groups was statistically significant（F=4.387,P=0.006）.Further analysis showed that TSH≥90mIU/L group There were differences between the TSH<30mUI/L group and the 30mIU/L group≤TSH<60mIU/L group;the total ER rate of 117 patients with non-distant metastasis PTC（27.4%）.The difference in the efficacy of different TSH levels between the non-distant metastatic PTC patients was statistically significant（X²=17.686,P=0.024）;when serum TSH≥90mIU/L,patients can reach the best ER rate and ¹³¹I treatment outcome.Univariate analysis showed that there were differences in the quality of TSH,Tg and residual nail between the prognosis group and the poor group.Binary Logistic Regression Analysis,and gender and age adjustment,the final conclusion is that the lower the TSH before treatment,the higher the Tg may be the independent influencing factor of poor prognosis;The first ¹³¹I for patients with non-distant metastasis PTC After radiation therapy mumps incidence of3.4%.Conclusion Serum TSH≥90 mIU/L can achieve better ¹³¹I treatment effect;the lower the TSH level and the higher the Tg level before ¹³¹I treatment,the worse the prognosis of non-distant metastatic PTC patients.A large dose of ¹³¹I treatment can also cause radioactive mumps.