Changes Of Thyroid Function And Cellular Immunity After Operation For Thyroid Papillary Microcarcinoma

Objective To investigate the changes of thyroid function and cellular immunity after operation for thyroid papillary microcarcinoma.Methods The clinical data of 90patients with thyroid micropapillary carcinoma diagnosed and treated in hospital from January 2014 to October 2018 were analyzed retrospectively.Among them,30 cases were treated by unilateral total resection plus isthmus resection,30 cases were treated by unilateral total resection plus contralateral subtotal resection,and 30 cases were treated by bilateral total resection.The levels of TT3,TT4,FT3,FT4 and TSH were compared before,1,3 and 5 days after operation.The levels of NK cells,CD3+T lymphocyte and CD4+T lymphocyte in patients before and 7 days after operation were compared.The operation time and bleeding volume were compared among the three groups.Results（1）There was no significant difference in preoperative FT3levels among the three groups（P>0.05）.The bilateral total resection group decreased significantly on the first day after operation,and continued to decline after operation.The unilateral+contralateral exact group decreased significantly from the third day after operation,while the unilateral+isthmus group decreased relatively slowly.（2）There was no significant difference in FT4 among the three groups before operation（P>0.05）.On the 1st day after operation,FT4 increased in all three groups,but there was no significant difference among the three groups（P>0.05）.On the 3^rd after operation,the bilateral total resection group decreased significantly,while the unilateral+contralateral subtotal resection group decreased significantly on 5^th day after operation.（3）There was no significant difference in TT3 among the three groups before operation（P>0.05）.TT3 decreased in unilateral+isthmus group,but there was no significant difference（P>0.05）.On 5^th day after operation,the unilateral+contralateral subtotal resection group and bilateral subtotal resection group decreased significantly.（4）TT4 decreased in unilateral+isthmus group,but there was no significant difference（P>0.05）.In the unilateral+contralateral subtotal resection group,there was a significant decrease on the 5^th day after operation,and in the bilateral subtotal resection group,there was a significant decrease on the 3^rd day after operation,and the decrease continued on the 5^th day after operation（P<0.05）.（5）TSH in the three groups showed a downward trend on the 1^st day after operation,and gradually increased on the 3^rdd day after operation.（6）There was no significant difference in NK cells,CD3⁺cells and CD4⁺cells between unilateral+isthmus group and preoperative group（P>0.05）.NK cells in unilateral+contralateral subtotal resection group and bilateral subtotal resection group were significantly higher than those before operation,while CD3⁺and CD4⁺after operation were significantly lower than those before operation（P<0.05）.（7）The operation time of unilateral+isthmic resection was（95.6±20.9）min,the shortest,followed by bilateral total resection group（135.3±22.6）min,unilateral+bilateral subtotal resection group（153.4±21.8）min,with significant difference among the three groups（P<0.01）.The bleeding volume in unilateral+isthmus group was（56.9±16.8）ml,the least,followed by bilateral total resection group,（79.7±23.8）ml,unilateral+contralateral subtotal resection group was the most,（103.4±22.9）ml,with a significant difference between the three groups（P<0.01）.Conclusion（1）Unilateral total thyroidectomy plus isthmus resection,unilateral total thyroidectomy plus contralateral subtotal thyroidectomy and bilateral total thyroidectomy are common surgical methods for the treatment of thyroid microcarcinoma.Unilateral subtotal thyroidectomy plus contralateral subtotal thyroidectomy and bilateral subtotal thyroidectomy retain little or almost no thyroid function.As a result,the level of thyroxine decreased significantly after operation,and continued to decline over time,which is not conducive to postoperative recovery.Patients should timely supplement thyroxine tablets according to the patient’s condition after operation.Unilateral total thyroidectomy plus isthmus resection retains some thyroid function,so the changes of thyroxine level in patients after operation are not as significant as those after unilateral total thyroidectomy plus contralateral subtotal thyroidectomy and bilateral total thyroidectomy.However,it is still necessary to decide whether to implement thyroxine supplementary therapy according to the level of thyroid hormone after operation.（2）The degree of immunosuppression after unilateral total excision plus contralateral subtotal excision and bilateral total excision is significantly higher than that after unilateral total excision plus isthmus excision,which may be related to the long operation time and large surgical trauma of the former two.Therefore,in clinic,unilateral total resection plus isthmus resection should be chosen as far as possible for patients who meet the indications of unilateral total resection plus isthmus resection.