Analysis Of The Relationship Between Perioperative Thyroid Hormone Levels And ECG Changes In Differentiated Thyroid Carcinoma

1.Objective:This paper is aimed at studying the changes of perioperative ECG among patients with thyroid papillary carcinoma,and exploring the influence of perioperative TH and TSH on the cardiac electro-physiologic activities of patients with DTC,which can provide preclinical clinical basis for further investigation in ECG variation in long-term TSH suppressive therapy after DTC.2.Methods:According to inclusion and exclusion criteria,we retrospectively analyzed the data of 65 patients who received thyroid surgery for the first time from January 2018 to December 2018 in Shandong Provincial Hospital(all confirmed as papillary thyroid carcinoma by pathology).All the patients in the group were operated by the same operator.34 cases underwent total thyroidectomy and central lyimphadenectomy,with or without lateral neck lymph node dissection.31 cases underwent unilateral thyroidectomy or unilateral and partial contralateral thyroidectomy,with central lymph node dissection.All the operation proceeded smoothly.We collected the regular 12-lead ECG,HR,PR,QRS,QT and QTc of patients in preoperative and postoperative 3 days,and measured thyroid stimulating hormone(TSH)?free thyroid hormone(FT4)?free triiodothyronine(FT3)in preoperative and postoperative 3 days using chemiluminescence.We made an univariate analysis on the influence factors of various perioperative ECG indices in each group with different operative method,and made a correlation analysis between thyroid hormone and ECG indices at the same time.All data was analyzed using SPSS22.0,and we assumed that p<0.05 meant statistical significanceResults:1.Changes of thyroid hormoneIn the group of total resection,serum TSH was higher postoperatively(P=0.002);serum fT3 was lower postoperatively(P=0.001);and serum fT4 was lower postoperatively(P=0.033).In the group of subtotal resection,there was no statistically significant differences in perioperative serum TSH,P=0.922.Serum fT3 was lower postoperatively(P=0.001);and serum fT4 was higher postoperatively(P=0.006)2.Changes of ECG indices during perioperative periodIn the total thyroidectomy group,The PR interval after operation was shorter than that before operation,and the difference was statistically significant(P=0.005).The duration of QRS wave after operation was shorter than that before operation(P=0014).HR,P wave,QT and QTc did not changes significantly during operative period(P>0.05).In the subtotal thyroidectomy group,postoperative HR was increasing and the difference was statistically significant(P=0.021).PR interval in postoperative period was shorter than that before operation,and the difference was statistically significant(P=0.012).The duration of P wave in postoperative period was shorter than that before operation with statically significant difference(P=0.036).No perioperative changes were observed in QRS duration,QT interval and QTc.3.Changes of ECG indices and influence factors3.1 There were 34 patients in the group of total thyroidectomy group,10 males and 24 females.7 patients had hyperlipidemia,and 27 patients had normal plasma lipid 11 cases with BMI<22.9Kg/m2,18 cases with BMI 22.9-28.5 Kg/m2,and 5 cases with BMI>28.5Kg/m2?3.1.1 Differences of changes of perioperative HR in different groups had statistical significance(P=0.043),patients whose age were over 55 had more obvious HR changes than those whose age were under 55.Difference among the BMI groups had statistical significance.There were no obvious differences between different sex groups,between lipid elevation and normal group,and also between low,normal and over BMI group.The change of perioperative fT3 was positively correlated with that of HR(r=0.476 P=0.004)?3.1.2 Dif-f-erences of changes in perioperative PQ duration in different groups all had no statistical significance(P>0.05);The change of perioperative tT4 was negatively correlated with that of PQ duration(r=-0.411 P=0.016)?3.1.3 Differences in changes of perioperative QRS in different groups had no statistical significance(P>0.05);The change of perioperative TSH?fT3?fT4 were all not correlated with that of QRS(P>0.05)?3.1.4 Differences in changes of perioperative QT in different groups had no statistical significance(P>0.05);The change of perioperative TSH?fT3?fT4 were all not correlated with that of QT(P>0.05)?3.1.5 Differences in changes of perioperative QTc between males and females were statistically significanct(P=0.027);changes of perioperative TSH?fT3?fT4 all had no correlation with that of QRS(P>0.05)?3.1.6 Differences of changes of perioperative P-wave in different groups were not statistically significant(P>0.05);changes of perioperative fT4 was negatively correlated with changes in P-wave(r=-0.416 P=0.014)?3.2 There were 31 patients in group of subtotal thyroidectomy,11 males and females.7 patients had hyperlipidemia,and 24 patients had normal lipid 9cases with BMI<22.9Kg/m2,18 cases with BMI 22.9-28.5 Kg/m2,and 4 cases with BMI>28.5 Kg/m2.3.2.1 Differences of perioperative changes of HR in different groups were not statistically significant(P>0.05),except in BMI groups.perioperative TSH?fT3?fT4 were all not correlated with HR(P>0.05)?3.2.2 Differences in changes of perioperative PQ in different groups were not statistically significan(P>0.05);The change of perioperative fT3 was negatively correlated with that of PQ(r=-0.357 P=0.048)?3.2.3 Differences in changes of perioperative QRS in different groups were not statistically significant(P>0.05);The change of perioperative TSH?fT3?fT4 were all not correlated with that of QRS(P>0.05)?3.2.4 Differences of changes of perioperative QT in different groups were not statistically significant(P>0.05);The change of perioperative TSH?fT3?fT4 were all not related to that of QT(.P>0.05)?3.2.5 Differences of changes of perioperative QTc in different groups were not statistically significant(/P>0.05);the change of perioperative TSH?fT3?fT4 were all not correlated with that of QTc(P>0.05)?3.2.6 Differences of changes of perioperative P-wave in different groups were not statistically significant(P>0.05);The change of perioperative TSH?fT3?fT4 were all not correlated with that of P-wave(P>0.05)Conclusions:Age,gender and BMI have a certain impact on the changes of perioperative ECG index.We should strengthen the monitor of cardiac function of elderly and obese patients.The change of thyroid hormones level was correlated with the change of perioperative ECG index.In the long-term TSH suppressive theory,a gender-age related ECG standard for DTC patients with different TH level should be established so that we could assess the cardiac function more accurate.