分化型甲状腺癌术后促甲状腺激素抑制治疗的共识和争议

doi:10.16139/j.1007-9610.2023.06.04

摘要/Abstract

摘要：

分化型甲状腺癌（differentiated thyroid carcinoma, DTC）是最常见的甲状腺恶性肿瘤，多数病人预后良好。手术、¹³¹I及促甲状腺激素（thyroid stimulating hormone, TSH）抑制是其目前主要的治疗手段。其中，TSH抑制治疗在DTC病人术后管理中发挥重要价值，具有降低复发风险、延缓疾病进展、改善长期生存的作用。同时，过度的TSH抑制可增加心血管系统和骨骼系统不良事件的发生风险。目前对于各类病人血清TSH的抑制目标仍存在争议。在临床实践中，应权衡TSH抑制带来的收益及潜在风险，结合病人随访期间的动态评估，个体化制定血清TSH的目标范围。本文就DTC病人术后TSH抑制强度、效益与风险以及目前存在的争议进行阐述。

关键词: 分化型甲状腺癌, 术后管理, 促甲状腺激素抑制治疗

Abstract:

Differentiated thyroid carcinoma (DTC) is the most common thyroid carcinoma, with a generally favorable prognosis for most patients. At present, Surgery, ¹³¹I and thyroid stimulating hormone (TSH) suppression are the main therapeutic means among which, TSH suppression therapy plays an important role in the postoperative management of DTC patients, which has the effect of decreasing the risk of recurrence, slowing down the progression of the disease, and improving long-term survival. However, excessive TSH suppression can increase the risk of adverse events in the cardiovascular and skeletal systems. Currently, there is ongoing debate regarding the optimal target range for serum TSH suppression in patients of all types. In clinical practice, it is important to carefully balance the benefits and potential risks of TSH suppression, and to personalize the target range for serum TSH based on dynamic assessments during patient follow-up. This article aimed to discuss the intensity, benefits, and risks of TSH suppression after surgery for DTC patients, as well as the current controversies about this topic.

Key words: Differentiated thyroid carcinoma, Postoperative management, Thyroid stimulating hormone suppression therapy

中图分类号:

R736.1

刘杰, 先柯瑶. 分化型甲状腺癌术后促甲状腺激素抑制治疗的共识和争议[J]. 外科理论与实践, 2023, 28(06): 507-511.

LIU Jie, XIAN Keyao. Consensus and controversy in postoperative thyroid stimulating hormone suppression therapy for differentiated thyroid carcinoma[J]. Journal of Surgery Concepts & Practice, 2023, 28(06): 507-511.

图/表 3

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复发风险分层	TSH抑制目标（mU/L）
高危	<0.1
中危	0.1~0.5
低危
Tg处于较低水平	0.1~0.5
Tg检测不到	0.5~2.0
腺叶切除	0.5~2.0

分类	生化指标	影像学指标
疗效满意	抑制性Tg<0.2 μg/L或刺激性Tg<1 μg/L	阴性
疗效不确切	抑制性Tg<1 μg/L，刺激性 Tg<10 μg/L，TgAb水平稳定或下降	非特异性影像学表现或碘扫描示甲状腺床微弱摄碘
生化疗效不佳	抑制性 Tg>1 μg/L 或刺激性 Tg>10 μg/L或TgAb水平呈上升趋势	阴性
结构性疗效不佳	Tg或TgAb呈任何水平	存在结构性或功能性病变的证据

TSH抑制治疗的不良反应风险	DTC动态疗效评估（mU/L）
TSH抑制治疗的不良反应风险	疗效满意	疗效不确切	生化疗效不佳	结构性疗效不佳
无或未知风险	0.5~2.0	0.1~0.5	< 0.1	< 0.1
低风险	0.5~2.0	0.1~0.5	0.1~0.5	< 0.1
中风险	0.5~2.0	0.5~2.0	0.1~0.5	< 0.1
高风险	0.5~2.0	0.5~2.0	0.5~2.0	0.1~0.5