| [Background] Thyroid cancer is the most common malignant tumor of the head and neck region. According to the statistics of thyroid cancer both at home and abroad, it’s incidence has been increasing year by year, especially in female. Differentiated thyroid carcinoma (DTC) accounts for about94～95%of thyroid cancer, and its treatment including surgery, radioactive iodine therapy and thyrotropin suppression etc. Postoperative thyrotropin suppression of DTC always need according to serum thyroid hormones levels. At present time, it is very important to adjust the dose of drug according to the serum thyroid hormones level, so as to achieve the right degree of suppression. But before the start of thyrotropin suppression therapy, how to chose the right time to begin thyrotropin suppression is also very important. But at present the reports about dynamic observation the change of serum thyroid hormones level of postoperative patients with DTC are relatively few.[Objectives] To dynamically observe the thyroid hormones level in postoperative patients with DTC, and to determine the optimal time period when start thyrotropin suppression according to the serum thyroid hormones level. So as to guide clinically rational use of drugs.[Methods]108cases with DTC in our hospital from October2010to December2011were selected. To dynamic observe the change of serum thyroid hormones level using the method of the electrochemical luminescence. All of the108cases were divided into two groups according to the surgical approach,56cases with total thyroidectomy and52cases with thyroid lobectomy and isthmusectomy. The patients of anterior group were drawn venous blood sample to check serum thyroid hormones level at the1st,2nd,4th,5th and7th days after surgery, while the patients of posterior group were drawn venous blood sample to check serum thyroid hormones level at the2nd,4th,7th and14th days after surgery, until the serum TSH have a rising tendency or up to more than2 mU/L.[Results] The change of serum thyroid hormones level is observed in all108cases. In total thyroidectomy group, the postoperative value of serum T3and FT3gradually decrease. The postoperative value of serum T4and FT4elevate transiently which reach the peak at the2nd day, after that, they start to decrease gradually and reach the lower limit of normal range at the7th day. While the postoperative value of serum TSH decrease transiently which reach the trough at the1st day, after that it starts to increase rapidly and soon surpasses the preoperative level and even higher limit of normal range while keeping on elevating. In lobectomy and isthmusectomy group, the postoperative value of serum T3and FT3decrease transiently which reach the trough at the2～4th day, after that, they start to decrease gradually, but are still lower than preoperative value till at the14th day. The postoperative value of serum T4and FT4elevate transiently which reach the peak at the2nd day, then gradually decrease, at the14th day they appear to be lower than preoperation value. The postoperative value of serum TSH decreases transiently which reach the trough at the2nd day, then it elevates gradually, at the7th day, it is near the preoperative value, and reaches the higher limit of normal range at the2nd week.[Conclusions] There is a dynamic change of serum thyroid hormones in postoperative patients with DTC. It is feasible to determine the optimal time window when start thyrotropin suppression according to the level of postoperative serum thyroid hormones. According to the results of this study, we suggest the thyrotropin suppression should be started at the4th±1days after surgery in the patients with total thyroidectomy, and at the10th±3days after surgery in the patients with thyroid lobectomy. In addition, considering the existing of individual differences, in order to avoiding subclinical hyperthyroidism or clinical hyperthyroidism, check serum thyroid hormones level through drowning venous blood sample in these time period should be performed. |
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