| Objective:Differentiated thyroid carcinoma(DTC)is the most common type of thyroid cancer Surgery,postoperative exogenous thyroid stimulating hormone(TSH)suppression,follow-up and monitoring of recurrence are still important management programs for most DTC patients.With the updating and revision of DTC diagnosis and treatment guidelines from home and abroad,the establishment of individualized targets for TSH suppression has gradually become the focus of hot discussion.Many literatures have confirmed that TSH suppression may cause harm to human health,but it is rarely reported whether it has negative interference on ovarian reserve for women of childbearing age.Serum anti-mullerian hormone(AMH)has been the most effective and sensitive index of evaluating ovarian reserve function so far,which is adopted in this article.At the same time,in order to explore whether the effect of TSH suppression on ovarian function is related to its source,patients with Graves’ disease were selected as the endogenous TSH suppression group,and the AMH levels of the two patient groups and healthy controls were evaluated to analyze what influence the exogenous and endogenous TSH suppression have on ovarian function for women of childbearing age.Methods:1.A total of 174 female patients who underwent postoperative TSH suppression for more than 3 years served as the DTC subjects in exogenous TSH suppression group.They were selected from the patients enrolling in the postoperative follow-up program conducted by China-Japan Union Hospital of Jilin University.These women,aged 26-52 years,did not experience menopause and regularly received levothyroxine(LT4).Chemiluminescence immunoassay was used to measure the levels of TSH,free thyroxine(FT4),free triiodothyronine(FT3),and AMH in serum which derived from the Venous blood samples.2.A total of 160 female patients served as the Graves’ disease subjects in endogenous TSH suppression group.They were selected from the patients enrolling in the clinical follow-up program conducted by The First Affiliated Hospital of China Medical University.These women,whose levels of thyroid function matched with DTC patients,aged 31-49 years,did not experience menopause.After Thyroid function examination,the AMH levels of residual serum were measured.3.A total of 40 healthy female individuals whose ages matched with DTC and Graves patients,served as healthy control group.These subjects,aged 30-47,were selected from people who underwent physical examination in the Physical Examination Center in The First Affiliated Hospital of China Medical University.After physical examination,the levels of TSH,FT4,FT3,and AMH in residual serum were measured 4.The general clinical data and menstrual history of the selected subjects were recorded and statistically analyzed accordinglyResults:1.There was no significant difference in the age and serum TSH level among postoperative TSH suppression group with 174 patients,Graves’ disease group with 160 patients and healthy control group with 40 individuals(P=0.50 and 0.41,respectively)There was also no significant difference in the serum AMH level[median(interquartile range)]among the three groups[0.93(0.36-1.69),1.13(0.41-2.29),and 1.15(0.22-2.72)ng/ml,P=0.38].2.The women with DTC were further divided into four subgroups according to the level of TSH suppression,i.e.,TSH<0.1 mIU/L group with 45 patients(T1 group),0.1 mIU/L≤TSH<0.4 mIU/L group with 37 patients(T2 group),0.4 mIU/L≤TSH<2.0 mIU/L group with 66 patients(T3 group),and TSH≥2.0mIU/L group with 26 patients(T4 group).The serum AMH levels in these subgroups and healthy control group were 0.77(0.29-1.48),1.03(0.48-1.91),0.95(0.37-1.48),0.73(0.10-2.36),and 1.15(0.22-2.72)ng/ml respectively,and there was no significant difference in serum AMH levels between these four subgroups and the healthy control group(P=0.10).Moreover,serum AMH level of patients in each subgroup was not correlated with TSH,FT4,and FT3(all P>0.05).3.According to above standard,the patients with Graves’ disease were further divided into four subgroups(n=40).The serum AMH levels of subjects in each subgroup and healthy control group were 0.88(0.31-2.05),1.10(0.42-2.88),1.29(0.65-2.71),0.99(0.38-2.04),and 1.15(0.22-2.72)ng/ml respectively,and there was no significant difference in serum AMH level between these four subgroups and the healthy control group(P=0.53).Serum AMH level of patients in each subgroup was not obviously correlated with TSH,FT4,and FT3 in TSH suppression patients(all P>0.05).4.Comparing patients with DTC and patients with Graves’ disease at the same TSH level,serum AMH level was not correlated with TSH,FT4,and FT3(all P>0.05)Conclusion:This study has not found significant difference in serum AMH level among women with DTC undergoing postoperative suppression therapy,Graves’disease in endogenous TSH suppression and healthy women of the same age,suggesting that exogenous and endogenous TSH suppression does not affect ovarian reserve.However,there is clearly a need for multicenter,large-scale trials to confirm this conclusion. |
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