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分化型甲状腺癌(differentiated thyroid cancer,DTC)占甲状腺癌的90%以上,包括甲状腺乳头状癌(papillary thyroid carcinoma,PTC)和甲状腺滤泡状癌(follicular thyroid carcinoma,FTC)两种类型[1]。目前,DTC的发病率在全世界范围内迅速增长,但疾病相关病死率较低[2-3]。DTC的治疗方案主要包括手术+131I治疗+TSH抑制治疗[4]。DTC起源于甲状腺滤泡上皮细胞,且仍然具有正常甲状腺组织的生物学特征,包括表达钠碘同向转运体、甲状腺过氧化物酶、甲状腺球蛋白等,以及具有摄取131I的能力[5]。131I治疗及诊断性显像前高水平TSH能直接刺激钠碘同向转运体的表达,增强残余甲状腺及转移病灶的摄碘能力,从而提高131I疗效及显像灵敏度,同时也能提高甲状腺球蛋白检测的灵敏度[4, 6]。
长期的甲状腺功能减退(简称甲减)会严重影响全身多脏器系统功能:加重神经精神疾病[7]及心血管疾病[8],导致肾功能下降[9],对脂质代谢产生负面影响[10],增加动脉粥样硬化的风险[11];同时降低机体各系统代谢水平,从而造成一系列典型的临床症状及体征[12],包括疲乏、怕冷、食欲不振、体重增加、月经紊乱、皮肤干燥、四肢及颜面部水肿等。在131I治疗及诊断性显像前的甲状腺激素撤退(thyroid hormone withdrawal,THW)期间,患者均处于短期的医源性甲减状态,停药期间患者的生活质量也会受到一定的影响[13],但是DTC患者的甲减症状能够在恢复服用左旋甲状腺素(L-thyroxine,L-T4)后得到纠正。由于结果的可逆性和THW方案的可变性,短期的甲减状态对机体的负面影响还有待进一步确认。
笔者将对甲状腺切除术后131I治疗及诊断性显像前提高TSH水平的方案及其对DTC患者131I清甲成功率、临床及生活质量的影响进行综述。
分化型甲状腺癌术后131I治疗及诊断性显像前提高TSH水平的方案及其影响
Methods for improving TSH level and their effect in postoperative patients with differentiated thyroid cancer
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摘要: 分化型甲状腺癌(DTC)术后131I治疗及诊断性显像前较高水平的促甲状腺激素(TSH)能增强131I疗效和提高显像灵敏度。提高TSH的方案主要包括甲状腺激素撤退(THW)及重组人TSH,但THW引起的急性甲状腺功能减退将导致血脂代谢异常、肾功能受损、心血管疾病和神经精神疾病,对患者的生活质量造成显著影响。笔者就目前应用于临床的两种提高TSH的方案及其对DTC患者临床和生活质量的影响进行综述。Abstract: A high level of thyroid stimulating hormone (TSH) is required to stimulate sufficient radioiodine uptake for diagnostic imaging or therapy. The current methods for improving TSH level include thyroid hormone withdrawal and recombinant human TSH. However, acute hypothyroidism caused by thyroid hormone withdrawal (THW) before radioactive iodine remnant ablation/treatment or diagnostic scanning significantly influences lipid metabolism, renal function, cardiovascular and neuropsychiatric diseases, and quality of life. This review aimed to summarize these methods and their effect on the clinical and quality of life in patients with differentiated thyroid cancer.
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Key words:
- Iodine radioisotopes /
- Thyrotropin /
- Hypothyroidism /
- Quality of life /
- Differentiated thyroid cancer
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