Influencing Factors And TCM Syndrome Factor Analysis Of Tsh Reaching Standard Time In Postoperative Patients With Papillary Thyroid Carcinoma After Thyroid Hormone Withdrawal

In recent years,papillary thyroid carcinoma（PTC）has attracted wide attention at home and abroad because of its increasing incidence.At present,the treatment of PTC is mainly combined with surgical resection,Radioactive Iodine（RAI）therapy and thyroid stimulating hormone（TSH）inhibition therapy,among which RAI therapy is a very important part of postoperative diagnosis and treatment.International guidelines recommend thyroid hormone withdrawal（THW）for more than 3 weeks before ¹³¹I treatment to ensure that plasma thyrotropin levels are higher than 30m IU/L,thus optimizing thyroid tissue uptake of RAI in the body.However,many studies have pointed out that thyroid hormone withdrawal will adversely affect the physiology,psychology and quality of life of patients,and the time required for patients with TSH to reach 30m IU/L is different,so the one-size-fits-all THW scheme is obviously wrong.Therefore,it will be very meaningful for patients to explore the reasons for the differences in TSH changes and to provide personalized THW programs.In addition,there is no lack of opinions on the treatment experience of the disease after operation in traditional Chinese medicine,but so far a standardized syndrome differentiation guidance system has not been formed.Objective:In this study,the TCM syndrome factor scale was used as a tool to dialectically analyze the patients with THW before RAI treatment,to observe the distribution of syndrome elements and syndrome types,and to explore the factors related to the standard of TSH,so as to better understand the reasons for the differences of TSH changes during THW.In order to provide a personalized THW program for RAI treatment patients,minimize the adverse reactions of patients during abstinence,and provide a basis for improving the quality of life of patients.Methods:Patients with papillary thyroid carcinoma who were admitted to the Department of Endocrinology in our hospital from January 2021 to January 2022 and were to receive ¹³¹I treatment were selected.According to the plasma TSH level at 2 weeks after thyroxine withdrawal,the patients were divided into two groups:group A（TSH≤30m IU/L）and group B（TSH>30m IU/L）.The TCM syndrome data and other clinical data were collected respectively.Finally,the information obtained is collated and analyzed.Result:1.Basic data of patients:Finally,195 patients were included in the study,of which the attainment rate was 52.82%at 2 weeks and 91.79%at 3 weeks.Among the 195 people,there were 92 in group A and 103 in group B.There were only significant differences in age,total cholesterol,low density lipoprotein and glomerular filtration rate between group An and group B（P<0.05）.2.Clinical data of traditional Chinese medicine:The distribution and diagnostic value of syndrome elements included in the patients were blood deficiency and qi deficiency,followed by phlegm coagulation and qi stagnation.Among the syndrome elements of disease location,liver is the most common.The most syndrome types were deficiency of both qi and blood,deficiency of both qi and yin and deficiency of yang and qi.Difference analysis results showed that there were significant differences in the distribution of Yin deficiency and the diagnostic values of Yin deficiency,Jin deficiency and Qi stagnation between the two groups（P<0.05）.In addition,the results of the distribution of syndrome types in the two groups showed that there was only a significant difference in the distribution of syndrome types of Qi and Yin deficiency（P<0.05）.3.The influence factors of TSH standard time:Binary logistic regression analysis showed that age and diagnostic value of TCM qi stagnation syndrome elements were independent and significant factors of TSH reaching the standard.Among them,the older the patient is,the longer it takes for TSH to reach the standard after THW[OR=0.96,95%CI（0.93-0.99）,P<0.05],and the shorter it takes for TSH to reach the standard if the patient has more qi stagnation[OR=1.03,95%CI（1.01-1.06）,P<0.05].4.Test efficiency analysis of independent factors:The efficiency analysis of age and the degree of qi stagnation showed that the diagnostic accuracy of age in reaching the standard of TSH and the diagnostic accuracy of the degree of qi stagnation were 0.68 and0.61 respectively,and when the best cutoff value of age diagnosis was 34.5 years old,the diagnostic specificity and sensitivity were 0.88 and 0.379 respectively.When the best cutoff value of qi stagnation degree is 25.9,the diagnostic specificity is 0.783 and the sensitivity is 0.456.Conclusion:It was found that the main pathological factors during THW were qi deficiency,blood deficiency,phlegm coagulation and qi stagnation.The disease site is mainly related to the liver.The distribution of syndrome type is mainly deficiency syndrome.In addition,the study also found that age and diagnostic value of TCM qi stagnation syndrome are the main independent and significant factors that affect TSH compliance.For young patients or patients with high scores of qi stagnation syndrome,especially those younger than 34.5 years old and those with scores of TCM qi stagnation syndrome higher than 25.9,the withdrawal time can be advanced correspondingly,and vice versa,so as to minimize the influence of THW on patients,which has certain guiding significance for clinic.However,the study still has some limitations,and multicenter large sample related studies are needed for further verification in the future,in order to improve the relevant diagnosis and treatment programs during iodine treatment of THW and improve the quality of life of patients.