甲状腺不同术式术后早期甲状腺激素变化研究

发布时间：2018-05-29 06:00

本文选题：甲状腺结节 + 甲状腺切除术　；参考：《吉林大学》2016年硕士论文

【摘要】：近年来我国甲状腺结节的发病率逐年增高。手术是治疗甲状腺良恶结节的常用手段。通过动态观察甲状腺不同术式术后早期甲状腺激素的变化规律,指导甲状腺术后内分泌治疗适宜的起始时间,减少医源性并发症的发生率,提高甲状腺结节患者的术后生活质量,使甲状腺术后的内分泌治疗更加科学规范。目的:动态研究甲状腺不同术式术后早期甲状腺激素变化规律。探讨不同术式下甲状腺术后给予内分泌治疗的适宜的起始时间。方法:选取2014年1月至2015年12月期间于吉林大学第二医院甲状腺外科行手术治疗的符合选择及排除标准的患者120例。按其手术方式分为四组,单侧甲状腺次全切除术组30例,双侧甲状腺次全切除术组30例,患侧甲状腺及峡部全切除术组30例,双侧甲状腺全切除术组30例。四组患者分别采集术后第1、3、5、7、14天空腹静脉血。应用ADVIA Centaur?XP全自动免疫分析系统及配套试剂采用电化学发光免疫分析法检测相应时段血清甲状腺激素水平。其中双侧甲状腺全切除组和患侧甲状腺及峡部全切除组60名患者术后病理证实为恶性。结果:对比观察120例患者术前及术后早期检测的甲状腺激素水平变化。甲状腺全切除术组术后血清tt3、ft3逐渐下降,于术后第5天略有升高,后再逐渐下降,但术后各时间点测得结果与术前比较均低于术前(p0.05);血清tt4、ft4术后第1天呈一过性上升趋势,后逐渐下降,术后第5天明显低于术前(p0.05),术后第7天降至正常低值附近,术后第14天明显低于正常低值(p0.05);血清tsh术后第1天呈一过性下降,后逐渐上升,于术后第3天明显高于术前(p0.05),术后第5天超过正常值高限,后继续升高。患侧甲状腺腺叶全切及峡部全切除术组血清tt3、ft3术后第1天、术后第3天一过性下降,术后第5天开始逐渐上升,术后各个时间点测得血清tt3、ft3值低于术前水平(p0.05);血清tt4、ft4术后第1天一过性升高,明显高于术前(p0.05),之后逐渐下降,于术后第14天降到正常低值附近;血清tsh术后第1天一过性下降,明显低于术前(p0.05),后逐渐上升,于术后第7天明显高于术前(p0.05),术后第14天明显超出正常值高值。双侧甲状腺次全切除术组血清tt3、ft3术后逐渐下降,术后第7天明显低于术前(p0.05),低于正常参考值下限,后逐渐上升,术后第14天与术前无明显差异(p0.05);血清tt4、ft4术后第1天术后第1天一过性升高,明显高于术前(p0.05),后逐渐下降,术后第14天明显低于术前(p0.05),血清tt4降到正常值低限附近,血清ft4低于正常值低限;血清tsh术后一过性下降,明显低于术前(p0.05),之后逐渐上升,术后第7天明显高于术前(p0.05),高于正常值高限。单侧甲状腺次全切除组血清TT3、FT3术后一过性下降,术后第3天明显低于术前(P0.05),后逐渐上升,术后第14天仍低于术前;血清TT4、FT4术后第1天一过性升高,明显高于术前(P0.05),后逐渐下降,术后第7天明显低于术前(P0.05),后逐渐上升,血清TT4术后14天与术前无明显差异(P0.05);血清TSH术后第1天一过性下降,明显低于术前(P0.05),后逐渐升高,第7天明显高于术前,后逐渐下降,术后第14天仍高于术前,但未超过正常值高值。结论:甲状腺不同术式术后早期甲状腺激素呈动态变化,且变化趋势不同;根据甲状腺手术切除范围的不同,术后早期血循环中甲状腺激素变化趋势不同,给予外源性甲状腺激素替代治疗及TSH抑制治疗的起始时间不同。单侧甲状腺切除术切除术后剩余甲状腺代偿功能较好,可在术后一个月内给予相对少量或不给予外源性甲状腺激素替代治疗;双侧甲状腺次全切除术后剩余甲状腺代偿功能不良,可在术后14左右给予外源性甲状腺激素替代治疗;双侧甲状腺全切除术后,可在术后第5天左右给予外源性甲状腺激素行TSH抑制治疗;患侧甲状腺及峡部全切除术后,可在术后第14天左右给予外源性甲状腺激素行TSH抑制治疗。因存在个体差异,所有患者应根据相应时间的甲状腺激素水平制定个体化的治疗方案。
[Abstract]:In recent years, the incidence of thyroid nodules in China is increasing year by year. Surgery is a common means for the treatment of thyroid benign and malignant nodules. Through dynamic observation of the changes in the early thyroid hormone after different thyroidectomy, the appropriate starting time of endocrine therapy after thyroid surgery is guided, the incidence of iatrogenic complications is reduced, and the thyroid is improved. The postoperative quality of life of the patients with nodules makes the endocrine treatment more scientific after thyroid surgery. Objective: to dynamically study the changes in the early thyroid hormone changes after different thyroidectomy. The appropriate starting time for the treatment of endocrine therapy after different surgical thyroidectomy was discussed. Methods: from January 2014 to December 2015. In the second hospital of Jilin University, 120 cases of surgical treatment of thyroid surgery were divided into four groups, 30 cases with unilateral subtotal thyroidectomy, 30 cases of bilateral thyroidectomy, 30 cases of lateral thyroid and isthmus resection, 30 cases of bilateral total thyroidectomy. Four groups of patients. The blood of the 1,3,5,7,14 sky abdominal vein was collected after the operation. The serum thyroid hormone levels were detected by the ADVIA Centaur? XP automatic immunoassay system and the auxiliary reagents by electrochemiluminescence immunoassay. 60 patients with bilateral thyroid total excision group and the affected side thyroid and isthmus total excision group were treated after surgical pathology. Results: the changes of thyroid hormone levels were observed in 120 patients before and after the operation. The serum TT3, FT3 decreased gradually after the total thyroidectomy group, slightly increased at the fifth day after the operation, and then decreased gradually, but the results were lower than before the operation (P0.05) after the operation (P0.05); serum TT4, FT4 after operation. The 1 day showed an upward trend, then decreased gradually, after fifth days obviously lower than before operation (P0.05), seventh days after the operation to the normal low value, fourteenth days after the operation was significantly lower than the normal low value (P0.05), the serum TSH after first days after a sexual decline, the third days after the operation was significantly higher than before the operation (P0.05), fifth days after the operation was higher than the normal value higher after the operation. Blood serum TT3, first days after FT3, first days after operation, third days after operation, first days after operation, and a gradual rise in fifth days after operation, and the serum level of FT3 was lower than that before operation (P0.05) at every time point after operation, and the serum TT4, FT4 after the operation was higher than that of preoperative (P0.05). After the operation, it descended to the normal low value fourteenth days after the operation, and the first days after the operation of serum TSH decreased obviously, obviously lower than that before operation (P0.05), and then increased gradually, at seventh days after the operation (P0.05), and fourteenth days after the operation. The serum of bilateral thyroid gland subtotal excision group was TT3, FT3 was gradually decreased after operation, seventh after operation. The day was lower than the preoperative (P0.05), lower than the normal reference value, and then increased gradually, and there was no significant difference between the fourteenth days after the operation (P0.05). Serum TT4, first days after the operation, first days after the operation increased, obviously higher than before (P0.05), then gradually decreased, fourteenth days after the operation (P0.05), serum TT4 dropped to the normal value of the low limit, serum, near the normal value of the low limit, serum, near the normal value of the low limit of serum, serum FT4 was lower than normal value, and the serum TSH decreased significantly after operation, which was obviously lower than before operation (P0.05), and then increased gradually. The seventh day after operation was significantly higher than that before operation (P0.05), higher than normal value. The serum TT3, FT3 after unilateral subtotal thyroidectomy group decreased after operation, and was significantly lower than before operation (P0.05) after operation (P0.05), and fourteenth days after the operation, The level of serum TT4 and FT4 increased first days after operation, which was significantly higher than before operation (P0.05), then decreased gradually, after seventh days obviously lower than before operation (P0.05), and then gradually increased, and there was no significant difference between 14 days after TT4 operation (P0.05) after the operation of serum TT4, and first days after TSH in serum decreased significantly, obviously lower than before (P0.05), and then gradually increased, seventh days obviously. It was higher than before the operation, and then decreased gradually, fourteenth days after the operation was still higher than the preoperative, but not higher than the normal value. Conclusion: thyroid hormone in different stages of thyroid surgery has a dynamic change, and the change trend is different. According to the different range of thyroidectomy, the change trend of thyroid hormone in the blood circulation in the early post operation is different, giving exogenous nail The initial time of the replacement therapy of adenoidectomy and TSH inhibition is different. The residual thyroid compensatory function is better after unilateral thyroidectomy, and a relatively small amount or no exogenous thyroid hormone replacement therapy can be given within one month after the operation; the residual thyroid compensatory function after bilateral thyroidectomy is poor. Exogenous thyroid hormone replacement therapy was given about 14 postoperatively, and exogenous thyroid hormones could be treated with TSH inhibition after fifth days after bilateral thyroidectomy, and exogenous thyroid hormones could be treated with TSH inhibition after fourteenth days after total resection of the affected thyroid and isthmus. All patients should develop individualized treatment based on thyroid hormone levels at the corresponding time.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R653

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