| Objective:To investigate the clinical factors of influencing serum thyroid stimulating hormone levels in patients with differentiated thyroid carcinoma who were not given or given a inhibitory dose of L-T4 after total thyroidectomy.Methods:There were 118 postoperative patients with DTC of China Japan Union Hospital of Jilin University from January 2016 to August 2016 included in the study.Inclusion criteria:?1?all of the patients were treated with total thyroidectomy,and DTC was diagnosed according to postoperative pathology,and it was consistent with the standard of 131? treatment;?2?withdraw L-T4 after surgery for 4 weeks,strict low iodine diet for 2 weeks;?3?thyroid static imaging with 99 m Tc O4-showed no significant radioactive distribution in the area of thyroid bed and ectopic thyroid;?4?Sign informed consent forms.Exclusion criteria:?1?contraindications of 131? treatment?white blood cells<3.0×109/L;severe impairment of liver and kidney function;pregnancy or lactation?;?2?patients have misused L-T4 during the preparation of 131? treatment or have given TSH suppressive therapy after operation.?3?a history of pituitary surgery or other pituitary lesions.?4?existing cardiac diseases or other heart disease risk factors and malabsorption;?5?distant metastasis.Register the patient's gender,age and other general information,and the body weight,height,body mass index?BMI?and serum TSH of all patients were measured by professional staff at 2,4weeks after operation and 4 weeks after 131? treatment.The patients were divided into two groups according to gender,and further divided into premenopausal and menopausal women.In addition,according to the WHO,s classification of age,the subjects were divided into three groups: youth?age<45 years?,middle age?45 ? age < 60 years?and old age?age ? 60 years?.The comparison among groups was done with an independent two sample t-test or rank test,and the correlation between sex,age,weight,height,BMI and serum TSH were analyzed by Univariate and multivariate analyses.Results:Serum TSH levels of>30m IU/L were 67% and 100% of the total number of patients at 2 and 4 weeks after operation,and the levels of serum TSH increased about 4.2 times at 2 to 4 weeks after operation.The serum TSH in the inhibition state was 0.988±0.735 m IU/L at 4 weeks after131? treatment,of which,30% of patients could achieve TSH inhibition requirements.2 weeks after operation:There were significant differences in serum TSH values between the two groups: men,premenopausal women and menopausal women.4 weeks after operation : The mean levels of serum TSH in menopausal women was higher than that in men,but the difference was not statistically significant,and the difference between the other groups still has statistical significance.4 weeks after131? treatment:the serum TSH of premenopausal women was higher than that of men and menopausal women,the difference was statistically significant,and there was still no difference between men and menopausal women.In addition,according to different age group,there was no significant difference in the serum TSH between the middle age group and the old group at 4 weeks after operation,comparison among remaining groups at each time point has statistical significance.The results of univariate analysis showed that serum TSH was positively correlated with female at 2 and 4 weeks after operation,and negatively correlated with age,body weight,height and BMI.Serum TSH was still positively correlated with female at 4 weeks after 131? treatment,and age,body weight,BMI negative correlation,and no correlation with height.Furthermore,multivariate analysis indicated that the serum TSH was independently correlated with gender,age and body weight at 2 and 4weeks after operation,among which the age was the most significant influencing factor.Serum TSH in the inhibition state was only correlated with gender and age at 4 weeks after 131? treatment.Conclusion:gender,age,and body weight are three independent factors that affect the levels of serum TSH in the stimulated state,achieving the target levels of serum TSH may take less time and rise faster in younger and lighter weight women after the same time of L-T4 withdrawal,which provides the possibility for us to develop an individualized management program before 131? treatment.Besides,serum TSH in the inhibitory state is associated with age and gender,We calculate the L-T4 starting dose after DTC,not only the actual weight but also the gender,age and other factors to take into account,in order to achieve individual TSH inhibitory dose. |
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