CAJ | 학술논문

目的探讨乳头状甲状腺癌(PTC)患者首次131I治疗清除残余甲状腺组织(清甲治疗)后第5天血清甲状腺功能指标的变化及临床意义.方法 PTC术后患者74例,首次131I清甲治疗剂量3.7 GBq,分别于131I治疗前1 d及治疗后第5天监测PTC患者血清FT3、FT4、TSH.以治疗前TSH水平分A、B两组:A组TSH＜30 mIU/L 22例,B组TSH≥30 mIU/L 52例.统计分析采用配对资料的符号秩和检验及相关性分析.结果 A组在131I治疗后第5天TSH下降87%,FT4升高88%,FT3升高87%,3项指标前后变化均有统计学意义(均P＜0.05),其中45%(10/22)患者达一过性甲状腺毒症水平.B组治疗后第5天三指标变化个体差异大,TSH小幅上升6%(P＞0.05);而FT4下降13%,FT3下降14%,前后变化有统计学差异(均P＜0.05).结论针对PTC患者首次清甲治疗后短期内,部分患者甲状腺功能指标会升高甚至出现一过性甲状腺毒症,而另一些患者甲状腺激素只轻微下降,个体变化差异大.所以针对清甲治疗后的甲状腺激素替代和抑制治疗宜根据血清甲状腺功能指标监测结果制定个性化治疗计划.
목적 탐토유두상갑상선암(PTC)환자수차131I치료청제잔여갑상선조직(청갑치료)후제5천혈청갑상선공능지표적변화급림상의의.방법 PTC술후환자74례,수차131I청갑치료제량3.7 GBq,분별우131I치료전1 d급치료후제5천감측PTC환자혈청FT3、FT4、TSH.이치료전TSH수평분A、B량조:A조TSH＜30 mIU/L 22례,B조TSH≥30 mIU/L 52례.통계분석채용배대자료적부호질화검험급상관성분석.결과 A조재131I치료후제5천TSH하강87%,FT4승고88%,FT3승고87%,3항지표전후변화균유통계학의의(균P＜0.05),기중45%(10/22)환자체일과성갑상선독증수평.B조치료후제5천삼지표변화개체차이대,TSH소폭상승6%(P＞0.05);이FT4하강13%,FT3하강14%,전후변화유통계학차이(균P＜0.05).결론 침대PTC환자수차청갑치료후단기내,부분환자갑상선공능지표회승고심지출현일과성갑상선독증,이령일사환자갑상선격소지경미하강,개체변화차이대.소이침대청갑치료후적갑상선격소체대화억제치료의근거혈청갑상선공능지표감측결과제정개성화치료계화.
Objective To investigate the patterns of change in thyroid functional parameters ( serum TSH,FT3, and FT4 ) in patients with papillary thyroid cancer (PTC) before and after the initial 131I treatment for thyroidal remnant ablation. Methods Seventy-four PTC patients, treated with 3.7 GBq 131 I therapy, were divided into two groups, group A with serum TSH＜30 mIU/L and group B with serum TSH ≥30 mIU/L the day before 131I treatment. Five days after the treatment, the patients were re-examined for serum FT3, FT4, and TSH levels.Results In group A (22 cases), 5 days after the 131I ablation treatment, FT4significantly increased by 88% and FT3 by 87%, while TSH decreased by 87% (all P＜0. 05 ), and 45% (10/22)cases manifested the signs of transient thyrotoxicosis. In group B (52 cases)after treatment, individual variance of FT3 and FT4 was obvious,with FT4 decreased by 13% and FT3 decreased by 14% ( both P＜0. 05 ), while TSH slightly increased by an average of 6% ( P＞0.05 ). Conclusion After the initial 131 I ablation therapy for thyroidal remnant, the thyroid hormone levels in some PTC patients significantly increase while in others may slightly decrease in the early stage. The supplementary and suppressive therapy after 131I ablation for PTC patients might be individualized depending on the thyroid hormone determination.