| Objective This study mainly analyzed the influencing factors of TSH level attainment and the influence of TSH inhibition therapy on thyroid function in patients with papillary thyroid cancer by comparing various observational indicators between the TSH level attainment group and the non-attainment group after postoperative TSH inhibition therapy.Methods In this study,patients admitted to the People’s Hospital of Xinjiang Uygur Autonomous Region from January 2018 to July 2019 who were pathologically diagnosed with papillary thyroid carcinoma after surgery and received TSH inhibition therapy after surgery（levothyroxine sodium was used to suppress TSH at a low normal value or below the lower limit of normal）were selected.According to the TSH level 12months after surgery,the patients were divided into TSH level conforming group and non-conforming group,and the general data（gender and age）of the two groups were compared.Preoperative serum free triiodothyronine,serum free thyroxine,serum thyrotropin,BRAF gene mutation rate,lymph node metastasis,and postoperative serum free triiodothyronine,serum free thyroxine,levothyroxine sodium tablet doses,and further analyze the correlation between the above observation indicators and TSH inhibition treatment standards.The influencing factors of TSH inhibition were screened out.Results1.A total of 237 patients with papillary thyroid carcinoma were finally included in this study.According to TSH level at 12 months,71 patients in the qualified group and 166patients in the substandard group;2.The ratio of male to female in the TSH standard group was 1:3.17,and the mean age was 48.42±9.76 years old.There were 24 patients（33.8%）with preoperative lymph node metastasis,with preoperative FT3of 3.03±0.33pg/ml and FT4of 1.3±0.20ng/dl.Preoperative TSH≥2.0m U/L in 20 cases（28.17%）,TSH<2.0m U/L in 51 cases（71.8%）,BRAF gene mutation in 59 cases（83%）,oral levothyroxine≥1.4μg/kg·d in 47 cases,accounting for 66.20%.No recurrence one year after surgery;3.The male to female ratio was 1:3.74,the mean age was 46.50±10.25 years old,and 51patients（30.7%）had preoperative lymph node metastasis.FT3and FT4before surgery were 2.98±0.44pg/ml and 1.32±0.19ng/dl,respectively.99 cases（59.64%）had TSH≥2.0m U/L and 67 cases（40.4%）had TSH<2.0m U/L.Among 129 patients with BRAF gene mutation（77.7%）,5 patients（3.01%）received levothyroid hormone dose≥1.4μg/kg·d after TSH inhibition therapy,and no recurrence occurred one year after surgery.4.Comparing the general data of the two groups,it was found that the two groups were mostly female and mainly in their 40（P>0.05）.There was no statistical significance between the two groups.5.Preoperative clinical data of the two groups showed no significant differences in lymph node metastasis,tumor size and BRAF gene mutation rate（P>0.05）,and there was no statistical significance between the two groups.6.In the two groups,more patients with TSH≥2.0m U/L before surgery in the non-conforming group than in the conforming group（P<0.05）,and the difference was statistically significant.7.The comparison of postoperative levothyroxine dose between the two groups showed that patients in the qualified group with oral levothyroxine dose≥1.4μg/kg·d were higher than those in the unqualified group（P<0.05）,and the difference was statistically significant.8.There was no significant difference in preoperative FT3and FT4between 2 groups（P>0.05）.The levels of FT3and FT4in the qualified group were higher than those in the unqualified group（P<0.05）,and the difference was statistically significant..conclusions1.Preoperative TSH level≥2.0m U/L,postoperative levothyrohormone dose<1.4μg/kg·d and complicated Hashimoto’s thyroiditis are associated with increased risk of postoperative TSH level substandard.2.For patients with papillary thyroid carcinoma,the TSH level reached the standard when the inhibitory dose of levothyroxine was administered after surgery can improve thyroid function better.3.The dose of levothyroid hormone should be adjusted in time according to the results of each follow-up of postoperative patients,so as to avoid the insufficiency of dose resulting in substandard TSH level inhibition. |
