单侧腺叶切除术后甲状腺功能变化的研究

探讨甲状腺良性结节行单侧腺叶切除术后甲状腺功能的变化情况及影响因素。回顾性分析2014年3月—2015年12月因甲状腺良性结节行单侧腺叶切除术的98例患者的临床资料,根据患者年龄不同分为中青年组(60岁69例和老年组(≥60岁29例;根据患者术前促甲状腺激素(TSH水平分为TSH较高组(TSH2.5 u IU/m L34例和TSH较低组(TSH≤2.5 u IU/m L64例;根据抗甲状腺过氧化物酶抗体(TPOAb水平分为TPOAb阴性组75例和TPOAb阳性组23例。各组患者分别在术前、术后1个月及3个月检测游离三碘甲状腺原氨酸(FT3、游离甲状腺素(FT4及TSH。老年组患者术前的TSH水平明显高于中青年组(P0.05。术后FT3、FT4较术前明显下降,TSH明显升高(P0.05。TSH较高组患者术后FT3、FT4明显下降,TSH明显升高(P0.05。TPOAb阳性组患者术前的TSH水平明显高于TPOAb阴性组(P0.05;术后FT3、FT4较术前明显下降,TSH明显升高(P0.05。老年患者、术前TSH水平高、TPOAb阳性与甲状腺功能减退的发生密切相关。不同人群行单侧腺叶切除术后甲状腺功能变化情况不同,老年患者、术前TSH水平高、TPOAb阳性可能是甲状腺功能减退的危险因素,对术后甲状腺功能减退的发生有一定预测价值。     

不同手术方法对甲状腺切除术患者血清甲状腺激素水平的影响

目的:探讨不同手术方法对甲状腺切除术患者血清甲状腺激素水平的影响。方法:选取行甲状腺切除术的120例患者为研究对象,其中40例单侧腺叶切除术,40例双侧次全切除术,40例全切除术。全切除术组在术后给予替代治疗,将单侧腺叶切除术和双侧次全切除术两组按照术后治疗方法的不同分为观察组和对照组,观察组给予替代治疗,对照组不给予。分析各组在术前,术后10 d,1个月,3个月时的总三碘甲状腺原氮酸(TT3),总甲状腺激素(TT4),游离三碘甲状腺原氨酸(FT3),游离甲状腺素(FT4)的变化。结果:单侧腺叶切除术和双侧次全切除术两对照组的FT3和FT4在术后10 d时较术前显著降低(P<0.05);双侧次全切除术对照组术后及1个月FT3和FT4均低于术前水平(P<0.05),3个月时恢复。单侧腺叶切除术和双侧次全切除术观察组和全切除术组各时间段甲状腺激素水平无统计学差异(P>0.05)。结论:甲状腺切除术在术后一段时间内会引起甲状腺激素水平降低,需采用替代疗法,以弥补术后出现甲状腺功能不足。     

甲状腺腺叶切除术对甲状腺结节患者甲状腺激素水平的影响分析

目的探讨单侧甲状腺切除术对甲状腺结节患者甲状腺激素的影响。方法回顾性医院2014年1月至2016年1月经B超等检查证实为甲状腺结节的90例患者临床资料。行单侧甲状腺结节腺叶切除术,为治疗组;另选取同期健康体检的健康人群90例作为研究对照组。比较两组血清甲状腺激素水平。结果治疗组患者术前血清甲状腺激素水平处于正常范围内,且与对照组相比较,P0.05;治疗组术后1周与术前比较,T_3水平则明显下降,TSH水平明显升高,P0.05;术后1个月血清T_3、T_4水平明显下降,TSH明显升高,P0.05。术后3个月血清各项甲状腺激素水平均恢复至正常范围,与术前比较,P0.05。结论应用单侧甲状腺腺叶切除术治疗甲状腺结节可致患者出现暂时性甲状腺功能不全,所以临床可予以激素替代治疗。     

不同年龄患者甲状腺腺叶切除术后甲状腺功能变化的研究

目的：探讨不同年龄甲状腺良性肿瘤患者行单侧腺叶切除术后甲状腺功能的变化及激素替代治疗的必要性。 方法：将120例因甲状腺良性肿瘤行单侧腺叶切除术的患者根据年龄不同分为青年组（≤30岁,23例）、中年组（<30~<60岁,69例）、老年组（≥60岁,28例）,检测各组患者术前及术后1周,1、3、6个月,1、2年游离三碘甲状腺原氨酸（FT3）、游离甲状腺素（FT4）和促甲状腺激素（TSH）水平。 结果：青年组FT3水平在术后1周、1个月时较术前明显降低（P<0.05）,后期各时间点则与术前无统计学差异（P>0.05）;FT4水平术后各时间较术前均无明显变化（P>0.05）;TSH水平在术后1周,1、3个月时较术前比明显升高（均P<0.05）,后期各时间点则与术前无统计学差异（P>0.05）。中年组术后各时间点FT3、FT4、TSH与术前比较均无统计学差异（P>0.05）。老年组患者FT3水平在术后1周,1、3个月时较术前明显降低（P>0.05）,后期各时间点则术前无统计学差异（P>0.05）;FT4水平在术后1、3、6个月时较术前明显降低（P<0.05）,其余各时间点则与术前无统计学差异（P>0.05）;TSH水平在术后1周,1、3、6个月时均较术前比升高（P<0.05）,后期各时间点则与术前无统计学差异（P>0.05）。3组患者均未出现临床甲状腺功能减退症状。 结论：不同年龄甲状腺良性肿瘤患者行单侧腺叶切除术后甲状腺功能恢复情况不同。中年患者术后代偿能力强,可不予激素替代治疗;青年对甲状腺激素需求量相对较大而老年患者代偿能力较差,故青年患者术后半年内、老年患者术后1年内给予激素替代治疗较合适。     

甲状腺腺叶切除术治疗甲状腺结节的临床研究

目的:探讨甲状腺腺叶切除术治疗甲状腺结节的临床意义。方法:回顾性分析收治的单侧甲状腺结节患者198例的临床资料,随机分为甲状腺腺叶切除术组(100例)及甲状腺次全切除术组(98例)。观察两组患者疗效、手术时间、出血量和并发症以及随访结果。进一步分析甲状腺腺叶切除术组患者50岁以上和50岁以下患者,术后不服用甲状腺素片,术前以及术后1周患者血清FT3,FT4的变化。结果:手术时间、出血量和并发症,两组间差异有统计学意义(P<0.05)。甲状腺腺叶切除术组两个年龄段比较,50岁以上组FT3,FT4在术后第1周明显下降,甲状腺功能低下患者比率高(P<0.05),50岁以下组FT3,FT4的变化不大(P>0.05)。结论:甲状腺腺叶切除术治疗甲状腺结节疗效较好,能有效减少甲状腺结节患者的手术并发症和复发。年龄大的患者,需进行替代治疗。     

甲状腺癌次全或全切除术后甲状腺功能的变化

目的 观察甲状腺癌行甲状腺叶全切或次全切术后甲状腺功能的变化,为术后补充甲状腺素提供时间和量的依据.方法 对我院2009年1月至2011年4月间行甲状腺叶全切或次全切除的88例甲状腺癌患者术前(0 d)、术后第1天(1 d)、术后第3天(3 d)和术后第5天(5 d)的甲状腺功能[游离三碘甲腺原氨酸(FT3)、游离甲状腺素(FT4)、血清三碘甲腺原氨酸(T3)、四碘甲腺原氨酸(T4)、促甲状腺激素(TSH)]进行检测,对比手术前后变化规律.结果 88例行甲状腺叶全切或次全切除患者的FT3和T3在各时点均呈下降趋势,差异有统计学意义(FT3:F =47.752,P＜0.01;T3:F=15.317,P＜0.01),且术后3d起FT3和T3逐渐上升接近正常值下限;FT4和T4术后1d均上升,随后逐渐下降,FT4值在0d、术后1d及5d差异无统计学意义(P＞0.05),T4值在0d、术后1d差异无统计学意义(P＞0.05),其余各时间点间差异均有统计学意义(P＜0.05);TSH在术后1d下降,3d及5d逐渐上升,TSH值在0d、术后1d差异无统计学意义(P＞0.05),其余各时间点间差异均有统计学意义(P＜0.05),且TSH在术后3d接近正常值上限,于术后5d超过正常值上限.结论 甲状腺癌患者行甲状腺全切或次全切除术后1d甲状腺功能不降或下降不明显,可不检测甲状腺功能和补充甲状腺激素;术后3d起甲状腺功能明显下降,应及时监测,并根据甲状腺功能下降情况适当补充甲状腺激素.     

甲状腺腺叶切除术治疗不同年龄甲状腺良性肿瘤患者的临床疗效比较

目的 分析甲状腺叶切除术治疗不同年龄甲状腺良性肿瘤患者的临床效果.方法 行单侧甲状腺腺叶切除术的甲状腺良性肿瘤患者150例,按照其年龄大小将其分成青年组、中年组以及老年组,每组各50例,比较三组患者术后1周,术后1、3、6、12个月的游离三碘甲腺原氨酸(FT3)、游离甲状腺素(FT4)以及促甲状腺素(TSH)水平与术前的差异,并比较术后并发症的发生情况以及生活质量评分差异.结果 青年组患者FT3水平术后1周[(3.76±0.98) pmol/L]、1个月[(4.08±1.11) pmol/L]与术前[(4.99±0.87) pmol/L]比较明显降低(P＜0.05),TSH水平在术后1周以及术后1、3个月与术前比较,差异有统计学意义(P＜0.05);中年组患者的FT3、FT4以及TSH水平与术前比较,差异无统计学意义(P＞0.05);老年组患者的FT3水平在术后1周以及1、3个月明显降低,FT4水平在术后1、3、6个月明显降低,TSH水平在术后1周以及1、3、6个月明显增高(P＜0.05).青年组术后并发症的发生率(8.0％)显著低于老年组(28.0％,P＜0.05).青年组和中年组患者的术后生活质量与术前比较差异无统计学意义(P＞0.05),但老年组患者术后生理职能、一般健康状况、精力以及精神健康等方面评分,与术前比较明显降低(P＜0.05).结论 甲状腺腺叶切除术治疗不同年龄甲状腺良性肿瘤患者的临床效果较好,但术后甲状腺功能恢复存在差异,尤其老年患者较差.     

二氧化碳气腹对术中血浆甲状腺素影响的观察

目的：探讨腹腔镜胆囊切除术（LC）中CO2气腹对甲状腺功能的影响。方法：全麻下胆囊切除术60例随机分为LC组（30例）和非腹腔镜组（30例）,于术前1日及术中不同时期抽取静脉血标本,用放射免疫法检测血浆甲状腺（TT3,TT4,FT3,FT4,rTs,TSH)的变化,结果：60例患者术前甲腺素水平均为正常。LC气腹后TT3,TT4,TSH升高（P＜0．01,与术前相比）,非腹腔镜者术中TT3有所一降。结论：LC术中甲状腺功能增强可能与CO2气腹有关。     

良性甲状腺疾病再手术的原因与预防

目的　探讨良性甲状腺疾病再手术的原因和预防措施。方法　回顾性分析 1988～2 0 0 2年我院收治的良性甲状腺疾病再手术 2 3例。结果　首次手术行甲状腺结节摘除术 12例 ,甲状腺一侧腺叶部分切除术 11例。术后病理报告结节性甲状腺肿 18例 ,甲状腺腺瘤 5例。再手术行甲状腺一侧腺叶及峡部切除术 4例 ,甲状腺次全切除术 19例。术后病理检查 :结节性甲状腺肿2 1例 ,桥本甲状腺炎 2例。术后无严重并发症。结论　结节性甲状腺肿复发是再手术的主要原因 ,选择合理的术式有助于减少再手术。     

超声造影在甲状腺良性结节微波消融中的应用

探讨超声造影在甲状腺良性结节微波消融中的应用价值。选取2019年8月—2022年5月宜兴市人民医院治疗的甲状腺良性结节患者80例，采用信封法将患者分为观察组（n=40）和对照组（n=40），观察组给予超声造影联合微波消融治疗，对照组给予常规超声联合微波消融治疗，观察两组手术时间、术中出血量、结节体积等差异。手术时间比较两组差异无统计学意义（P>0.05）；观察组术中出血量和术后1个月结节体积分别为（6.10±1.43）m L和（4.56±1.04）cm3，明显低于对照组（P<0.05）。两组术前及术后1个月游离三碘甲腺原氨酸（FT3）、总三碘甲腺原氨酸（TT3）、游离甲状腺素（FT4）、总甲状腺素（TT4）和促甲状腺激素（TSH）比较差异无统计学意义（P>0.05）。并发症发生率比较，两组差异亦无统计学意义（P>0.05）。超声造影辅助甲状腺良性结节微波消融治疗，其消融效果好，术中出血少。     

腔镜下原发性甲亢腺叶切除术对血浆甲状腺素的影响

目的:研究腔镜下甲亢腺叶切除术对血浆甲状腺素的影响。方法:9例全麻下行腔镜下原发性甲亢腺叶切除术,分别于术前,术中不同时间及术后1周采血,用放射免疫法测定血浆甲状腺素(TT3,TT4,TSH)。结果:9例术前TT3,TT4均高于正常值。腔镜手术开始后,TT3,TT4,TSH显著升高(P<0.05),但全麻下患者MAP,HR显著低于术前(P<0.05),并保持平稳。结论:较深的全身麻醉降低代谢水平,可保障甲亢患者腔镜手术时的安全。     

甲状腺动脉栓塞治疗Graves病后甲状腺激素水平的变化

目的探讨甲状腺动脉栓塞治疗格雷夫斯病（GD）后5年内甲状腺激素水平的变化情况。方法回顾性分析49例接受甲状腺动脉栓塞治疗的GD患者术前、术后3天、7天、1个月、3个月、1年、3年、5年的T3、T4、FT3、FT4、TSH值变化。结果栓塞术后7天T3、T4,FT3、FT4均开始下降,至1～3个月最低,1年时反弹,之后呈现缓慢下降或小范围波动;术后3～7天,TSH下降至正常值以下,之后在正常范围内波动。结论甲状腺动脉栓塞治疗GD术后1～3个月甲状腺激素降至最低,1年开始反弹,提示术后1年是疾病复发的时间节点。     

髋关节置换术中碘伏冲洗对患者甲状腺功能的影响

目的探讨髋关节置换术术中使用碘伏冲洗消毒对患者术后甲状腺功能的影响。 方法2017年1月至2017年9月将诊于上海长海医院关节外科拟行髋关节置换术的50名患者(无甲状腺疾病及髋关节感染患者),随机分为两组：实验组(术中于假体置入后应用碘伏冲洗、浸泡消毒5 min)25例,对照组(使用生理盐水冲洗、浸泡5 min)25例。两组术后采用相同的康复训练方案。采集所有患者术前、术后第1天,第1周以及第1个月促甲状腺素(TSH)、游离三碘甲状腺原氨酸(FT₃)、游离甲状腺素(FT₄)以及尿碘的结果,评估术后以及术后1 d、1周及1个月与术前相比变化的程度。各时间点的组间差异采用配对样本t检验。 结果50名患者均顺利完成手术,且术后至少随访1个月。实验组FT₃术前为(4.4±0.8)pmol/L,术后第1天、1周、1个月分别为(1.7±0.3)、(4.7±0.7)、(4.3±1.0)pmol/L,对照组术前为(4.2±0.7)pmol/L,术后1 d,1周、1个月分别为(2.9±0.5)、(3.8±0.8)、(4.5±0.9)pmol/L;实验组FT₄术前为(15.4±3.6)pmol/L,术后第1天、1周、1个月分别为(10.7±2.5)、(12.1±2.7)、(15.3±3.5)pmol/L,对照组术前为(15.1±3.8)pmol/L,术后1 d,1周、1个月分别为(13.9±2.7)、(14.6±2.3)、(15.7±3.1)pmol/L;实验组TSH术前为(2.6±1.3)mIU/L,术后1 d、1周、1个月分别为(1.3±0.3)、(3.1±1.0)、(2.36±1.9)mIU/L,对照组术前为(2.6±1.0)mIU/L,术后1 d,1周、1个月分别为(1.3±0.3)、(2.0±1.1)、(2.5±1.5)mIU/L;实验组术前尿碘(251±97)μg/L,术后1 d、1周、1个月为(919± 224)、(453± 106)、(253±112)μg/L,对照组术前为(254±98)μg/L,术后1 d,1周、1个月分别为(262±215)、(255±107)、(244±94)μg/L。两组组间相比术后1 d及1周TSH、FT₃、FT₄以及尿碘值比较差异有统计学意义(术后1 d TSH：t＝0. 892,术后1 d FT₃：t＝7.165,术后1 d FT₄：t＝3.296,术后1 d尿碘值：t＝8.184,均为P <0.05;术后1周TSH：t＝2.691,术后1周FT₃：t＝3.339,术后1周FT₄：t＝2.754,术后1周尿碘值：t＝5.092;均为P <0.05),而术后1个月TSH、FT₃、FT₄以及尿碘值比较差异无统计学意义(均为P>0.05)。 结论术中使用碘伏冲洗对患者甲状腺功能有一过性影响,在术后第1天影响最大,1周后逐渐恢复,1个月后几无影响。     

术前TSH水平与甲状腺结节良恶性关系

目的：探讨血清促甲状腺激素（TSH）浓度与甲状腺结节良恶性的关系。 方法：回顾性分析近3年间收治的421例甲状腺结节患者的临床资料,其中结节性甲状腺肿347例,甲状腺癌74例。比较良恶性甲状腺结节患者血清TSH浓度差异,并分析TSH浓度与甲状腺结节的恶性风险以及甲状腺癌不同病理类型与血清TSH浓度的关系。 结果：甲状腺癌患者血清TSH浓度明显高于结节性甲状腺肿患者[（2.57±3.32）mIU/L vs. （1.67±2.90）mIU/L]（P<0.05）;甲状腺结节的恶性风险随血清TSH浓度的升高而逐渐升高,当TSH>5 mIU/L时,恶性率为50.0%;甲状腺癌不同病理类型间血清TSH浓度无统计学差异（P>0.05）。 结论：甲状腺结节恶性风险随血清TSH浓度的升高而增加,术前血清TSH测定可以作为甲状腺结节良恶性判断的一个辅助性指标。     

Binding of bovine thyrotropin to specific sites in thyroid tissue from control and hemithyroidectomized rats

The binding of 125I-bovine thyrotropin to thyroid particulate fractions from sham-operated (control) and hemithyroidectomized rats was compared to determine if a change in either the number of bovine thyroid-stimulating hormone (bTSH) binding sites or their affinity for bTSH occurs in physiological situations that evoke changes in the intensity of thyroid stimulation. Following hemithyroidectomy serum TSH levels increase and the remnant thyroid lobe enlarges. Because of compensatory thyroid hypertrophy the concentration of TSH binding sites in the thyroid glands from hemithyroidectomized and control rats was related to particulate protein concentration, to the degree of thyroid cellularity as indicated by DNA concentration, and to the concentration of the plasma membrane markers, 5'-nucleotidase and magnesium-dependent ATPase. In each of four experiments, saturation studies revealed that the maximum specific binding of TSH per unit particulate protein and per thyroid lobe was greater in particulates from remnant than from control thyroid lobes. When related to DNA concentration, the concentration of TSH binding sites in remnant lobes was approximately twice that in control lobes. Because of an increase in plasma membrane markers per lobe after hemithyroidectomy, however, there was no difference in the number of TSH binding sites when related to the concentrations of the membrane marker enzymes in the particulate fractions. As judged from Scatchard analysis, the affinity of TSH binding was lower in remnant than in control lobes. This was partially but not completely due to the increased concentration of particulate protein in the remnant thyroid. These experiments demonstrate that the increase in serum TSH levels after hemithyroidectomy in the rat is associated with alterations in TSH receptor capacity and affinity.     

Hypothyroidisim following hemithyroidectomy: incidence, risk factors, and management

BACKGROUND: The purpose of this study was to characterize the hypothyroidism that occurs following hemithyroidectomy. METHODS: The records of all euthyroid patients who underwent hemithyroidectomy from 1992 to 2000 were reviewed to determine the frequency of postsurgical hypothyroidism and the predisposing factors. All patients were evaluated for age, gender, serum thyrotropin (TSH) levels, weight of resected thyroid tissue, and associated thyroiditis. Hypothyroid patients were evaluated for symptoms, timing of diagnosis, and treatment doses of levothyroxine (L-T(4)). RESULTS: Hypothyroidism was diagnosed in 25 (35%) of 71 patients, subclinical in 16 and overt in 9 with a mean postoperative TSH level of 8.51 +/- 6.53 microIU/L. The mean preoperative TSH level was 1.94 +/- 1.00 microIU/L in hypothyroid compared with 1.10 +/- 0.74 microIU/L in euthyroid patients (P <.05). Lymphocytic thyroiditis was present in 10 (40%) of 25 hypothyroid compared with 10 (22%) of 46 euthyroid patients (P = not significant). There were no significant differences in age, gender, or weight of resected thyroid tissue. The average therapeutic dose of L-T(4) was 1.3 microg/kg (range, 0.5 to 1.9 microg/kg). All but 2 hypothyroid patients were diagnosed within 2 months of operation. CONCLUSIONS: Hypothyroidism following hemithyroidectomy occurs in patients with higher preoperative TSH levels, is usually mild and asymptomatic, and can be treated with reduced doses of L-T(4).     

TSH水平与甲状腺乳头状微小癌之间的关系探讨

目的探讨促甲状腺激素(TSH)与甲状腺乳头状微小癌之间的关系。方法回顾性分析2006年1月至2016年2月手术治疗的341例甲状腺结节患者,根据病理结果分为两组:甲状腺乳头状微小癌组104例,良性甲状腺结节组237例,收集并比较各组临床实验资料。数据分析采用SPSS 19.0统计软件,计量资料采用(x珋±s)表示,患者在年龄、结节直径、TSH浓度、淋巴结转移与TSH关系比较使用t检验;甲状腺乳头状微小癌发生率与TSH的关系采用χ2趋势检验,以P0.05表示差异具有统计学意义。结果甲状腺乳头状微小癌组患者结节直径平均为(1.92±1.13)cm,低于良性甲状腺结节组患者的(2.82±1.44)cm(t=-5.654,P0.05);甲状腺乳头状微小癌组患者TSH平均为(3.01±1.51)μIU/ml,高于良性甲状腺结节组患者的(1.90±1.32)μIU/ml(t=6.836,P0.05),差异均有统计学意义;按照TSH水平分为0.34μIU/ml、0.34~1.00μIU/ml、1.01~2.00μIU/ml、2.01~5.60μIU/ml和5.60μIU/ml,甲状腺乳头状微小癌组发生比例分别为11.76%、14.29%、23.94%、39.06%和53.33%,检验结果显示TSH水平越高其甲状腺乳头状微小癌的发生率越高(χ2=28.783,P0.05);甲状腺乳头状微小癌伴淋巴结转移患者TSH为(5.07±1.31)μIU/ml、明显高于无淋巴结转移患者的(2.83±1.55)μIU/ml,差异比较有统计学意义(t=5.844,P0.05)。结论 TSH可作为预测甲状腺乳头状微小癌风险的指标之一,可为临床诊断提供参考依据。     

Free thyroxine, free triiodothyronine and thyroid-stimulating hormone before and after hemodialysis in Saudi patients with end-stage renal disease: is there any difference?

Patients on regular hemodialysis (HD) suffer from a chronic illness that is believed not to involve the thyroid gland. However, they may have low levels of serum thyroxine (T4) and tri-iodothyronine (T3). It was found earlier that serum total T3 and free T4 concentrations were significantly higher immediately after a HD session than before. In this single-center prospective study, we evaluated the difference between free T3 (FT3), free T4 (FT4) and thyroid-stimulating hormone (TSH) levels before and immediately after HD sessions in 40 Saudi patients with end-stage renal disease undergoing regular HD at the Prince Salman Center for Kidney Disease, Riyadh, Saudi Arabia. The study involved 23 female and 17 male patients with a mean age of 49.65 ± 16.20 years. None of the study patients had any known thyroid disease. We measured the thyroid hormones monthly for three successive months using the electrochemiluminescence technique both before and after HD sessions. At the end of our study, we found a statistically significant difference between pre-HD and post-HD levels for FT3; in the first month, it was 4.47 ± 1.01 versus 4.86 ± 1.03 pmol/L, (P = 0.004); in the second month, it was 4.48 ± 1.37 versus 4.83 ± 1.64 pmol/L, (P = 0.008); and in the third month, it was 3.84 ± 0.88 versus 4.04 ± 0.84 pmol/L, (P = 0.003). The FT4 in the first month was 15.42 ± 2.75 pmol/L versus 17.20 ± 2.85 pmol/L, P = 0.000, in the second month it was 14.86 ± 2.66 versus 16.74 ± 3.27 pmol/L, P = 0.000 and in the third month it was 14.86 ± 3.93 versus 16.70 ± 4.00 pmol/L, P = 0.000, respectively. However, the pre- and post-HD levels of TSH did not show any statistically significant difference; in the first month it was 3.17 ± 1.47 versus 3.32 ± 1.39 pmol/L, P = 0.254, in the second month it was 2.57 ± 1.36 versus 2.49 ± 1.29 pmol/L, P = 0.299 and in the third month it was 2.36 ± 1.17 versus 2.44 ± 1.22 pmol/L, P = 0.238, respectively. Thus, there was a statistically significant increase in the post-HD levels of FT3 and FT4 although the TSH levels did not show any significant change. Our study suggests that measurement of TSH alone might be more reliable in the assessment of thyroid function in patients on regular HD than FT3 and FT4.     

Hemithyroidectomy: long-term effects on parathyroid function--preliminary report

Early hypocalcemia after thyroid surgery has frequently been reported, whereas data regarding long-term effects on calcium homeostasis are scarce. We have previously studied patients after hemithyroidectomy with an oral calcium load test and found normal parathyroid hormone (PTH) suppression. However, the 1,25-dihydroxyvitamin D concentration was decreased and the phosphate concentration increased, implying parathyroid insufficiency. We therefore proceeded to investigate PTH secretion and suppression in 10 euthyroid patients subjected to hemithyroidectomy due to benign thyroid disease before and at 1 year after surgery. In addition, biochemical variables known to influence calcium homeostasis were analyzed. Basal, maximal, and total PTH secretion were unaltered 1 year postoperatively. However, maximal PTH secretion was reached at a lower serum level of ionized calcium, and there was a tendency toward increased parathyroid sensitivity to ionized calcium. Furthermore, compared to preoperative, total serum calcium, 1,25-dihydroxyvitamin D, and free thyroxine (T4) concentrations were decreased at follow-up. Total serum calcium and 1,25-dihydoxyvitamin D concentrations were decreased 1 year after hemithyroidectomy. These changes were not due to parathyroid insufficiency. Instead, our results imply increased parathyroid sensitivity to calcium and possibly reduced peripheral sensitivity to PTH.