分化型甲状腺癌患者需要个体化的TSH抑制

分化型甲状腺癌(DTC)流行特征在变化,促甲状腺素(TSH)抑制疗法也在改进.TSH的抑制程度,既要考虑分化型甲状腺癌复发和患者死亡的危险,也应考虑TSH抑制治疗可能带来的危害.不同的分化型甲状腺癌患者需要不同的TSH抑制程度.

Abstract：

The epidemic characteristics of differentiated thyroid cancer(DTC)are changing, thyrotropin(TSH)suppressive therapy is also improving in recent years. The risks of recurrence and the death of patients, as well as the adverse effects of levothyroxine sodium treatment should be fully considered during thyroid hormone administration for patients of DTC. Hence, the degree of TSH suppression should be individualized in patients with DTC.     

重组人促甲状腺素介导分化型甲状腺癌的131I治疗

目的 研究重组人促甲状腺素(rhTSH)介导分化型甲状腺癌131I治疗对内源性TSH、甲状腺球蛋白、FT3、FT4的影响及其清甲成功率.方法 31例(年龄14～70岁,其中女性23例)接受rhTSH介导的131I治疗(甲状腺功能正常组),31例(年龄23～72岁,其中女性22例)停用甲状腺素后的行131I治疗[甲状腺功能减退组(甲减组)]观察注射rhTSH前后血清TSH、FT3、FT4以及甲状腺球蛋白抗体(TGAb)、甲状腺球蛋白浓度变化,以及131I治疗后6～12个月131I全身诊断显像评价其疗效.结果 使用rhTSH前后,血清TSH、甲状腺球蛋白、FT3、FT4的平均浓度分别是(1.08±4.01)和(140.26±27.20)mIU/L(P＜0.05)、(23.75±132.92)和(169.58±178.49)μg/L(P＜0.05)、(4.52±1.16)和(4.42±1.11)pmol/L(P＞0.05)、(15.09±5.83)和(13.66±5.85)pmol/L(P＞0.05).诊断剂量131I-全身显像显示甲状腺功能正常组24/31(77.4%)及甲减组22/31(71.0%)被考虑成功清甲(P＞0.05).以甲状腺球蛋白评价两组131I治疗疗效统计学无显著差异(P＞0.05),甲状腺功能正常组20/31(64.50%)及甲减组18/31(58.06%)被考虑成功清甲.结论 使用rhTSH能有效刺激内源性TSH增高,提高生活质量,获得较高的清甲成功率.使用rhTSH能有效刺激血清甲状腺球蛋白,有利于监测肿瘤残存、复发与转移.

Abstract：

Objective To observe the influence of recombinant human thyrotropin(rhTSH)on serum concentration of endogenous thyrotropin(TSH), free triiodothyronine(FT3), free thyroxine(FT4), thyroglobulin antibody(TGAb), and thyroglobulin(Tg). To evaluate the efficacy of rhTSH-aided radioiodine treatment in patients with differentiated thyroid carcinoma(DTC). Methods The study recruitment took place between November 2007 and March 2009. 62 patients(including 45 females)with biopsy confirmed DTC had undergone total or nearly total thyroidectomy, and received 131I treatment. 31 patients(including 22 females), median age of 45 years(23-72), received radioiodine treatment 4 weeks after L-thyroxine(T4)withdrawal. The other 31 patients(including 23 females), median age of 44 years(14-70), underwent rhTSH-aided radioiodine treatment. Before and after rhTSH injection, serum TSH, FT3, FT4, TGAb, and thyroglobulin were tested. Post-radiotherapy whole body scan was performed 5 to 7 days after radioiodine treatment and qualitatively and blindly evaluated by two nuclear medicine physicians. Follow-up took place 6 to 12 months after radioiodine treatment. The efficacy of rhTSH-aided radioiodine treatment was evaluated by whole body scan with diagnostic dose radioiodine. SPSS 13.0 statistical software was applied. Results (1)Before and after rhTSH-aided radioiodine treatment, the serum TSH was(1.08±4.01)vs(140.26±27.20)mIU/L(P＜0.05), thyroglobulin(23.75±132.92)vs(169.58±178.49)μg/L(P＜0.05), FT3(4.52±1.16)vs(4.42±1.11)pmol/L(P＞0.05), and FT4(15.09±5.83)vs(13.66±5.85)pmol/L(P＞0.05),respectively.(2)rhTSH-aided radioiodine ablation treatment had the same effect as L-T4withdrawal aided. The complete response ratio was 77.4% vs 71.0%(P＞0.05)by radioiodine whole body scan of diagnostic dose. Conclusion rhTSH-aided radioiodine treatment of DTC was effective and safe, and did at least at equivalent degree as did L-T4withdrawal. Furthermore, Serum thyroglobulin level could be effectively stimulated by rhTSH with tumor relapse or metastasis.     

甲氧氯普胺在介入治疗中的应用

甲氧氯普胺(Metoclopram ide)是临床常用的止吐药,可通过阻滞多巴胺受体而作用于延脑催吐化学感应区,具有强大的中枢性镇吐作用。还可加强胃及上部肠段的运动,促进小肠蠕动和排空,松弛幽门窦和十二指肠冠,从而提高食物通过率,这些作用也可增强本品的镇吐效应[1]。故临床常用口服或肌注治疗放疗、化疗等其他原因引起的呕吐。在240例癌症患者的介入治疗中,我们采用经导管动脉推注来预防化疗药物所引起的呕吐,现将结果报道如下。1资料与方法1·1一般资料癌症患者240例,其中肝癌153例,肺癌46例,胃癌33例,肠癌3例,胰腺癌2例,膀胱癌2例,子宫癌1例…     

分化型甲状腺癌的TSH抑制治疗

TSH抑制治疗是分化型甲状腺癌的传统治疗手段之一,能降低肿瘤进展高危患者的复发率和死亡率,但它有潜在的心血管系统和骨骼系统的不良反应,因此,TSH抑制治疗应同时考虑可能带来的益处和潜在的不良反应风险,进行个体化治疗.

Abstract：

TSH suppression therapy plays an important role in differentiated thyroid carcinoma. It can lower mortality and recurrence rate in high risk patients. Meanwhile, it also has potential side effects on cardiovascular and skeletal systems. Thus, TSH suppressive therapy should be individualized in regard to its possible benefit and potential adverse effects.     

分化型甲状腺癌的合理治疗

分化型甲状腺癌(differentiated thyroid cancer,DTC)占甲状腺癌的绝大部分,主要包括乳头状甲状腺癌(papillary thyroid cancer,PTC)和滤泡状甲状腺癌(follicular thyroid cancer,FTC)2种类型。     

颈丛神经的保留在分化型甲状腺癌手术中的应用

通过对95例分化型甲状腺癌联合根治术的回顾性研究,对保留颈丛神经、颈横动脉的根治效果、术后功能障碍进行评价,所得数据进行,检验。发现保留颈丛及颈横动脉的功能性甲状腺癌联合根治术,其术后耳廓、枕部皮肤感觉及肩功能的恢复明显优于经典的功能性颈清术（P〈0．05）;术后颈部淋巴结的复发率两种手术方法无统计学差异（P〉0．05）。提示对于分化型甲状腺癌,颈淋巴结分期在cN0-cN1n．的病例,在施行功能性颈淋巴结清除术时,对颈丛神经及颈横动脉的保留术式合理,能有效地改善生活质量。     

分化型甲状腺癌预后因素分析

目的探讨影响分化型甲状腺癌预后的相关因素。方法对658例接受手术治疗的分化型甲状腺癌患者的临床资料作单因素和多因素分析。结果单因素分析显示,性别、年龄、肿瘤大小、肿瘤侵犯程度、分期、淋巴结转移、远处转移、癌灶数目与分化型甲状腺癌预后有关;COX多因素分析显示,年龄、分期、淋巴结转移、肿瘤侵犯程度、远处转移与分化型甲状腺癌预后有关。结论分期、淋巴结转移、年龄、肿瘤侵犯程度、远处转移是影响分化型甲状腺癌预后的主要因素。     

促甲状腺激素抑制疗法对分化型甲状腺癌术后患者TRAb、TPOAb、TgAb的影响

目的 观察促甲状腺激素(TSH)抑制疗法对分化型甲状腺癌(DTC)术后患者促甲状腺素受体抗体(TRAb)、抗甲状腺过氧化物酶抗体(TPOAb)、甲状腺球蛋白抗体(TgAb)的影响.方法 DTC患者106例随机分为两组各53例.入选者均接受全甲状腺切除术治疗,术后观察组接受TSH抑制疗法,对照组接受甲状腺素替代疗法,治疗...     

FDG-PET在分化型甲状腺癌诊断中的应用

18F氟脱氧葡萄糖(FDG)正电子发射型计算机断层(FDGPET)在分化型甲状腺癌的诊断中有一定的临床价值。研究显示它不仅可用于甲状腺癌原发灶的诊断,而且在肿瘤分期、术后再分期、治疗效果评价和疾病预后评价方面可能具有更大的价值。葡萄糖转运蛋白、己糖激酶活性是影响病灶对FDG摄取的正相关因素,而葡萄糖6磷酸酶活性则与药物摄取呈负相关关系。此外,肿瘤灶内炎症细胞的浸润、肿瘤细胞缺血、损伤,以及血清促甲状腺素水平都可能影响病灶对FDG的摄取。     

微RNA-21与微RNA-19在老年分化型甲状腺癌患者中的表达及临床意义

目的:探讨微RNA-19(miR-19)和微RNA-21(miR-21)在老年分化型甲状腺癌(DTC)患者中的诊断价值,分析其与老年DTC患者病理特征的关系。方法:回顾性研究,入选2015年1月至2018年1月96例老年DTC患者,均行颈淋巴结穿刺和甲状腺癌根治手术,检测穿刺组织、DTC组织及癌旁组织的miR-21和m...     

131I联合左旋甲状腺素对分化型甲状腺癌术后患者骨代谢的影响

观察^131I联合左旋甲状腺素（LT4）替代治疗或抑制治疗对120例分化型甲状腺癌（DTC）术后患者部分骨代谢生化指标及骨密度的影响。替代组、抑制组与健康对照组血钙、血磷、血碱性磷酸酶（ALP）、骨密度（BMD）的差异无统计学意义，不同^131I累积剂量组间血钙、血磷、ALP、BMD的差异亦无统计学意义。观察期内所有患者无一例发生骨折。对DTC术后患者给予^131I联合替代或抑制剂量的LT4治疗是安全和必要的，该策略在短期内不会引起骨代谢生化指标和BMD的明显异常。     

Serum thyrotropin concentration as a biochemical predictor of thyroid malignancy in patients presenting with thyroid nodules

PURPOSE: Serum thyrotropin (TSH) is a well-established growth factor for thyroid nodules and suppression of TSH concentrations by administering exogenous thyroxine may interfere with the growth of established nodules as well as the formation of new thyroid nodules. The aim of this study was to investigate whether serum TSH at presentation is a predictor of thyroid malignancy in patients with thyroid nodules. METHODS: A total of 565 patients without overt thyroid dysfunction, who presented with palpable thyroid nodule(s) between 1988 and 2004 and underwent at least one fine-needle aspiration biopsy, were retrospectively evaluated. RESULTS: The final diagnostic outcome was established after surgery (n = 122) or after a minimum of 1-year clinical follow-up period. Higher rates of malignancy were observed in patients with serum TSH in the upper tertile of the normal range (P = 0.026). Binary logistic regression analysis revealed significantly increased adjusted odds ratios for the diagnosis of malignancy in patients with serum TSH 1.5-4.0 mIU/l when compared to those with either TSH 0.4-0.8 mIU/l (P = 0.005) or TSH 0.9-1.4 mIU/l (P = 0.007). CONCLUSIONS: The risk of malignancy in thyroid nodules increases in parallel with TSH concentrations within the normal range. TSH concentration at presentation is an independent predictor of thyroid malignancy.     

分化型甲状腺癌术后规范化管理

分化型甲状腺癌术后规范化管理是保证患者长期生存的关键.术后数周应根据术中情况、肿瘤病理、分子生物学特征、血浆甲状腺球蛋白水平、颈部超声等评估初始复发危险度以指导临床初始治疗方案及术后两年随访计划的制定与实施.根据患者对初始治疗的反应性,术后两年后应重新评估危险度以指导长期随访方案的制定.放射性碘治疗、促甲状腺激素抑制治疗、外照射治疗等是手术治疗的重要补充;随访中甲状腺球蛋白水平、甲状腺功能、超声、细针穿刺等监测手段是规范化管理的重要依据.     

Revisiting serum thyroglobulin in the follow-up of patients with differentiated thyroid carcinoma

This study analyzed serum thyroglobulin (Tg) during hypothyroidism in 207 patients with differentiated thyroid carcinoma treated with total thyroidectomy and radioiodine ablation and undetectable anti-Tg antibodies. Disease staging was defined by clinical examination, stimulated Tg, pre- and post-ablative radioiodine scanning, and other imaging methods (X-Ray, US, CT and MIBI-scan). The average interval from initial therapy was 2.3 years. 153 patients (74%) had no evident disease, 34 (16.4%) presented neck/mediastinal disease, and 20 (9.6%) had distant metastases (Mt). The best cut-off for Tg was 1 ng/ml, showing 100% sensitivity for distant Mt and 88.2% for local recurrence or lymph node Mt, and 88.8% specificity for any Mt and 74.8% for distant Mt. In patients with Tg <1 ng/ml, 2.8% showed cervical lymph nodes Mt. Cervical or mediastinal disease were 26% of cases with Tg between 1 and 5 ng/ml. Tg from 5 to 10 ng/ml was associated to distant Mt in 14.2% of the cases and others showed lymph nodes Mt. In patients with Tg >10 ng/ml, 51.3% presented distant Mt. We suggest the need for neck US even in cases with Tg <1 ng/ml. In addition, patients with Tg levels <5 ng/ml should be investigated by neck US and mediastinal CT only, and empirical therapy should be limited to patients with a minimum Tg level >5 ng/ml.     

Recombinant TSH in ablative therapy and follow-up of patients with differentiated thyroid carcinoma

The studies evaluating the efficacy and safety of recombinant TSH in the ablative therapy and follow-up of patients with differentiated thyroid carcinoma by serum thyroglobulin (Tg) measurement and iodine scanning were reviewed in this article. Recombinant TSH is comparable to hypothyroidism in the generation of Tg and in the execution of iodine-131 whole-body scanning, with the advantage of sparing patients from the symptoms of hypothyroidism and from impaired quality of life induced by levothyroxine withdrawal, in addition to a reduced exposure to elevated TSH and shorter absence from work, with recombinant TSH being the preparation indicated for the diagnosis of metastases in both low risk (Tg after recombinant TSH) and moderate or high risk patients (Tg and iodine-131 scanning after recombinant TSH). In the case of ablative therapy, the results are promising when using a dose of 100 mCi for remnant ablation, but hypothyroidism is still preferred, except for patients in whom the desired TSH elevation after levothyroxine withdrawal is not achieved, patients with base diseases that are aggravated by acute and severe hypothyroidism (severe heart and lung disease, coronary disease, compromised renal function, history of psychosis due to myxedema), patients debilitated by advanced disease, and elderly individuals. The studies also show that the administration of recombinant TSH is safe, with few mild or moderate adverse effects.     

甲状腺特异性转录因子对甲状腺功能的调控

甲状腺特异性转录因子是调控甲状腺功能的小分子蛋白,包括甲状腺转录因子(TTF)-1、双链复合蛋白(Pax)-8和TTF-2。生理状态下,促甲状腺激素、胰岛素和胰岛素样生长因子-1通过对TTF-1、TTF-2和Pax-8的表达及活性的调节,上调钠碘同向转运体、甲状腺过氧化物酶、甲状腺球蛋白、促甲状腺激素受体的表达,调节甲状腺功能。Pax-8和TTF-1也可使主要组织相容性复合物Ⅰ表达下调,使甲状腺可以耐受自身激素合成过程中增加的基因产物。TTF-1也可影响人类各组织中5′脱碘酶2型以及甲状腺滤泡旁细胞(C细胞)和甲状旁腺细胞中钙离子转运相关基因的表达。     

二甲双胍在甲状腺疾病治疗中的作用

二甲双胍是治疗糖尿病较为安全、有效的一线药物之一.近年来,有研究报道糖尿病患者常伴有甲状腺功能减退症及甲状腺结节增生,其甲状腺癌的发病率也明显增加.而服用二甲双胍可以改善胰岛素抵抗、减轻高胰岛素血症,降低促甲状腺激素(TSH)水平,减少甲状腺结节的增生,并阻滞细胞周期进程,抑制甲状腺癌细胞的增殖,协同增强化学治疗药物的敏感性.因此,二甲双胍有可能在辅助治疗甲状腺疾病中发挥重要角色.