Changes Of Thyroid Hormone In Patients With Different Operative Methods In The Early Stage Of Thyroid Surgery

Through the dynamic observation of changes of thyroid hormone in the early postoperative thyroid surgery, guiding thyroid postoperative endocrine therapy optimal starting time, reduce the incidence of iatrogenic complications, to improve the operation of thyroid nodule patients quality of life after the endocrine therapy of thyroid surgery more scientific and standardized.Objective:Dynamic study on the changes of thyroid hormone in the early stage after operation of thyroid gland, and to explore the appropriate initial time of endocrine therapy after the operation.Methods:120 cases of surgical treatment of thyroid surgery in our hospital from January 2014 to December 2015 were selected and excluded.Divided into four groups according to the mode of operation, Divided into four groups according to the mode of operation, unilateral thyroid subtotal surgery group(n = 30), bilateral thyroid subtotal surgery group(n = 30),suffer from side of thyroid and isthmus resection group(n = 30), thyroid bilateral total resection surgery group(n = 30).Four groups of patients were collected respectively, the blood of the 1st,3th,5th,7th,14 thfasting venous blood.Application of ADVIA Centaur? XP automatic immune analysis system and supporting reagent by electrochemiluminescence immunoassay analysis of thyroid hormone level in serum was detected in the corresponding period.The total thyroidectomy group and ipsilateral thyroid and isthmus resection group of 60 patients with pathologically confirmed malignant.Results:The changes of thyroid hormone levels before and after operation in120 patients were observed. The postoperative value of serum TT3 and FT3 of total thyroidectomy group gradually decreased, at the 5thday after the operation there was a slight increase, and then gradually decreased,the time before and after surgery were lower than preoperative(P<0.05).The postoperative value of serum TT4 and FT4 showed a transient upward at 1stday, then after a gradual decline,at the 5thday after surgery was significantly lower than that before surgery(P<0.05),at the 14 thday after operation was significantly lower than the normal value(P<0.05);The postoperative value of serum TSH showed a transient decrease at the1 stdays after the operation, after the gradual rise, significantly higher than those before operation at the 3thday(P<0.05),higher than normal valueafter the 5thdays, then continue to rise.In the unilateral thyroid gland lobe resection and isthmus total resection surgery group, the postoperative value of serum TT3 and FT3 decrease transiently at 1st-3thday,at 5thdays after surgery began to rise gradually, and was lower than the preoperative which measured at different time points(P<0.05); The postoperative value of serum TT4 and FT4 show a transient upward at 1stday than before operation(P<0.05), then after a gradual decline,at the 14 thday dropped to normal low level,;The postoperative value of serum TSH decrease transiently at the 1stday,which was significantly lower than the preoperative(P<0.05),then gradually increased, that was significantly higher than preoperative at the 7thday(P<0.05),at 14 thdays after surgery was significantly higher than the normal value.The postoperative value of serum TT3 and FT3 of bilateral thyroid subtotal resection group decrease gradually,at the 7thday was significantly lower than that before operation(P < 0.05), which is lower than the normal reference value limit,then gradually rise,,at the 14 thday have no sigincreased gradually nificant difference(P > 0.05); The postoperative value of serum TT4 and FT4 increase gradually than that before operation(P < 0.05) at the 1st day,then gradually decrease, at the 14 thdays was significantly lower than that before operation(P < 0.05), the postoperative value of serum TT4 dropped to normal value low limit, the postoperative value of serum TT4 lower than normal value low limit; The postoperative value of serum TSHwith transient decline was significantly lower than that before operation(P < 0.05), then gradually rise,at the 7thday after surgery significantly higher than that before operation(P<0.05),which higher than the normal high limit.The postoperative value of serum TT3 and FT3 of unilateral thyroid subtotal resection group gradually decreased that was significantly lower than that before operation at the 3thday(P<0.05), after gradually increased which is lower than that of before operation at the14thday(P < 0.05); The postoperative value of serum TT4 and FT4 increase at the 1stday than that before operation(P<0.05),and then decreased gradually,was significantly lower than that before operation at the 7thday(P < 0.05) after gradually increased,at the 14 thday after surgery the postoperative value of serum TT4 have no significant difference with preoperative(P > 0.05); The postoperative value of serum TSH decrease gradually at the 1stday than that before operation(P<0.05),and then increase gradually, that was significantly higher than that before operation at the 7thday, and then decrease gradually, which is still higher than that before operationat the 14 thday after surgery,but not higher than the normal value.Conclusion:The level of thyroid hormone in blood circulation of different surgical methods of thyroid hormone after operation show dynamic changes and different change; according to different thyroid resection range, differentthyroid hormone change after thyroid surgery in different time in blood circulation trend,exogenous thyroid hormone replacement therapy and TSH inhibition treatment of different starting time. Unilateral thyroidectomy after resection of residual thyroid compensatory function is betterin one month after operation,given relatively little or no exogenous thyroid hormone replacement therapy; bilateral thyroid gland resection of residual thyroid compensatory dysfunction, alternative therapy in the treatment of exogenous thyroid hormoneat at the 14 thpostoperative days;total thyroidectomy after, can give hormone for exogenous thyroid TSH suppression therapy at the 5thpostoperative days; and the unilateral thyroid isthmus After resection, at about the 14 thpostoperative day can be given exogenous thyroid hormone, TSH suppression therapy. Due to the existence of individual differences, all patients should be individualized treatment plan was worked out according to the levels of thyroid hormone in the corresponding time.