Study About The Role Of Ultrasound In Monitoring Thyroid Function In Patients With Metastatic Renal Cell Carcinoma Treated With Targeted Drugs

Objective:To study the thyroid function and thyroid function in patients with renal cell carcinoma using targeted drugs by observing the changes of thyroid function in patients with metastatic renal cancer treated with targeted drugs.Materials and Methods:37 patients with metastatic renal cancer(renal clear cell carcinoma)who received a targeted treatment from September 2016 to April 2018(19 patients taking sunitinib,18 for Solarnon)and a change in the concentration of serum TSH in the course of treatment,The enrolled patients were divided into a hypothyroidism group and a non-thyroid hypofunction group.In all cases,the concentrations of FT3,FT4 and TSH in the serum were measured by the Roche method before and after taking the medicine,and the volume and the peak velocity of the peak systolic peak of the thyroid were measured by means of the ultrasonic measurement of the radial lines of the bilateral leaves and the isthmus of the thyroid.The changes of TSH,FT3,FT4,thyroid volume,rate of change of thyroid volume,STA-PSV,STA-PSV rate of change of the thyroid and the RI of the thyroid on the thyroid were compared.To evaluate the value of ultrasound in the change of thyroid function.Results:37 patients with renal cell carcinoma with targeted drug:20 patients with hypothyroidism(mean time of 6.4 months with hypothyroidism)and 17 patients without hypothyroidism.The thyroid volume was 17.65(2.33)cm3,16.97(2.11)cm3,16.31(2.24)cm3,16.05(2.18)cm3,15.91(2.16)cm3,15.55(1.87)cm3,14.95(1.77)cm3,14.87(1.78)cm3 and 15.55(1.87)cm3,14.95(1.77)cm3,14.87(1.78)cm3,16.06(1.91)cm3,15.93(1.86)cm3,15.73(1.71)cm3,15.51(1.68)cm3,respectively.The thyroid volume change rate was 0.84(0.47)%,3.36(1.34)%,6.95(1.42)%,8.57(1.66)%,9.15(0.55)%,10.40(1.12)%,13.30(1.53)%14.15(1.85)%,respectively,after the initiation of the target therapy for hypothyroidism(n=20).The thyroid volume change rate was 0.25(0.11)%,3.00(1.81)%,5.09(1.81)%,6.72(1.81)%,6.90(1.35)%,9.90(1.35)%,10.60(1.79)%in the non-thyroid hypofunction group(n=17),respectively,and the statistical result has significant difference(p<0.05).The target therapy was 32.61(3.52)cm/s,25.80(2.56)cm/s,22.40(1.93)cm/s,19.27(1.24)cm/s,17.93(1.99)cm/s,15.63(1.24)cm/s,17.93(1.95)cm/s,15.63(1.55)cm/s,no hypothyroidism(n=17)targeted to the pre-treatment STA-PSV of 31.51(3.25)cm/s,the first,second,3,4,5,6,9,and 12-month STA-PSV were 29.31(3.25)cm/s,respectively.29.94(6.57)cm/s,25.55(2.99)cm/s,22.66(2.01)cm/s,22.29(1.92)cm/s,19.88(1.69)cm/s,18.29(1.55)cm/s.The rate of change of STA-PSV was 21.25(6.41)%,23.31(3.40)%,27.40(1.05)%,32.00(3.80)%,34.35(3.15)%,37.35(4.07)%,42.30(2.87)%,46.95(2.84)%,respectively,after the target treatment for patients with hypothyroidism(n=20).The rate of change of STA-PSV was 16.92(5.31)%,19.25(2.65)%,23.52(4.62)%,29.12(6.75)%,31.25(3.85)%,35.15(4.35)%,39.12(4.15)%,35.51(3.15)%,and the difference between the two groups of STA-PSV was not statistically significant(p>0.05).The resistance index of the first,2nd,3rd,4th,5th,6th,9th and 12th of the thyroid hypofunction group(n=20)was 0.49(0.09),0.51(0.08),0.54(0.18),0.52(0.11),0.62(0.11),0.64(0.12),0.68(0.02),0.69(0.15)respectively,and the resistance index of the thyroid on the first,2nd,3rd,4th,5th,6th,9th and 12th month was 0.49(0.09),0.51(0.08),0.54(0.18),0.52(0.11),0.62(0.11),0.64(0.12),0.68(0.02),0.69(0.15),and the resistance index of the non-hypothyroid group(n=17)was 0.42(0.22).The resistance index of the thyroid artery was 0.43(0.17),0.46(0.21),0.53(0.11),0.55(0.13),0.59(0.20),0.62(0.17),0.64(0.15)and 0.65(0.22)respectively in the first,second,3,4,5,6,9 and 12 months after the start of the targeted therapy.The sensitivity of ultrasound to the monitoring of hypothyroidism was 8.5%,70.3%,94.1%,93.3%,75.0%,respectively.The area under the ROC curve(AUC)was 0.845.Conclusion:The target of the treatment of metastatic renal cell carcinoma can cause the reduction of the volume of the thyroid,the decrease of the STA-PSV and the increase of the RI of the STA.The change of the thyroid function after the target therapy of the renal cell carcinoma can be directly monitored by the ultrasonic examination of the rate of change of the thyroid volume,the potential diagnostic value of the thyroid function is reduced,and the sensitivity,specificity and accuracy of the diagnosis of the hypothyroidism are high in the case of the volume change rate of 8.5%,The rate of change of STA-PSV does not reflect the change of thyroid function in patients with renal cell carcinoma treated with targeted drugs.