| Background and Aims:The current international guidelines recommend high risk group of papillary thyroid carcinoma (PTC) patients afterthyroid stimulating hormone (TSH) level should be controlled at<0.1mIU/L, but the elderly postoperative medication complications of younger patients is much higher, so the postoperative TSH control level is still in dispute. Therefore, the purpose of this study was to explore the optimum level of TSH in serum of elderly patients after PTC control, can effectively prevent the recurrence and metastasis of PTC and few complications, so as to guide the rational use of drugs in clinical work, obtain the long-term survival and a good quality of life in patients with postoperative.Methods:In this study, data from the First Affiliated Hospital of Medical College of Zhejiang University and Zhejiang Province People’s Hospital, two hospitals from2006January to 2013June in the group of patients were followed up, the follow-up period of1years,3years and5years, were papillary thyroid cancer after surgery in elderly patients, aged from75to the first operation83years old, the average age of80years, a total of73cases. According to thecontrol level of TSH is divided into A, B, C three groups, the ratio of male to female was1:2. Endocrine therapy:thedrug levothyroxine (L-T4) euthyrox, euthyrox conventional oral50ug-150ug, the morning fasting, once a day. At the early stage of thyroid function in patients with regular monthly review, according to the thyroid stimulating hormone (TSH) doses euthyrox level adjustment, and the maintenance of T3, T4in the normal range. Endocrine therapy for3to6months to stabilize after thyroid function, review every3months, including the level of TSH, and the serum thyroglobulin (TG), bloodglucose, serum calcium, electrocardiogram, heart, neck, B ultrasound examination, bone density examination and mental health.Data were analyzed by SPSS16soft analysis, count data expressed as percentage of the number of cases andcompared using x2test, when P<0.05had significant difference.Results:1. one year follow up studyAll of the73cases of papillary thyroid cancer postoperative patients were divided into3groups, were giveneuthyrox operation, daily50-150ug orally1times a day, after every3months regularly to outpatient review:A group TSH is controlled in0.3～0.5m IU/L, B group is controlled in0.1～0.3mIU/L, C control in0.1mlU/L. Results one year follow-up, no recurrence of thyroid cancer is found, the individual patient, arrhythmia, high blood sugar or osteoporosis, but there was no significant difference between the three groups (P>0.05). No difference in survival rate. 2. three years follow up studyA, B two groups each with2cases of thyroid cancer recurrence and metastasis, in group C,1cases of recurrence, but no significant difference between three groups (P>0.05), and cardiac arrhythmias, anxiety and insomnia and osteoporosis, the proportion of A in C group were significantly different (P<0.05). There was no significant difference on angina pectoris, hyperglycemia group, there was also no difference in survival (P>0.05).3. five years follow up study.All patients were divided into A, B, C three groups, the results of thyroid cancer recurrence and metastasis has no significant difference between the three groups (P>0.05). There were significant differences between the three groups of osteoporosis (P<0.05). A, B two groups of arrhythmia, anxiety and insomnia proportion had significant difference (P<0.05). A, C group of high blood glucose ratio have significant difference (P<0.05). No difference in survival rate. Cause of death was myocardial infarction or cerebral hemorrhage,1cases died of recurrence and metastasis.Conclusions:This study shows that control the level of TSH, no significant difference of recurrence and metastasis in patients with PTC after operation, and the arrhythmia, osteoporosis, anxiety and insomnia were significantly different(P<0.05), there was statistical significance. So that the control of TSH such as A level in elderly patients after PTC(0.3-0.5mIU/L) that the low normal range, rather than the operation risk PTC patients generally think the TSH should be controlled at0.1mlU/L (C group). |
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