甲状腺切除术后甲状腺功能减退症替代治疗的研究

摘要

目的 探讨甲状腺手术后甲状腺功能减退症(术后甲减)患者左旋甲状腺素钠( L-T4 )的合适替代治疗剂量. 方法 术后甲减患者93例,根据甲状腺残留量分为全切组21例、非全切组72例,替代治疗后计算并比较两组单位体重剂量( Per/kg body mass dosing,PBMD)的差异,并分别比较两组PBMD与1. 6 μg/kg剂量的差异;对非全切组男女患者L-T4 替代治疗剂量与体重的关系分别进行线性回归分析. 结果 全切组与非全切组患者PBMD分别为( 1. 8 ± 0. 1 )μg/kg、( 1. 4 ± 0. 2 )μg/kg,与 1. 6 μg/kg 剂量对比,差异均有统计学意义(P<0. 05,P<0. 01);两组均数比较差异亦有统计学意义(P<0. 01). 非全切组男女患者替代治疗剂量分别为(99. 0 ±16. 8)μg、(93. 0 ±18. 1)μg,两者差异无统计学意义(P=0. 153);非全切组男女患者L-T4 替代治疗剂量与体重均高度相关. 结论 术后甲减患者的L-T4 替代治疗剂量需根据患者甲状腺的残留量和性别来制定.%Objective To explore the replacement therapy dosage of levothyroxine (L-T4) in patients with postoperative hypothyroidism. Methods 93 patients with postoperative hypothyroidism were divided into subtotal-re-section group (n=72) and complete-resection group (n=21) according to the quality of residual thyroid tissue. Per/kg body mass dosing ( PBMD) of all patients were calculated and compared between the two groups after completion of replacement therapy. The 1. 6 μg/kg dosage was compared with PDBM of the two groups. The relationship between body weight and replacement therapy dosage in subtotal-resection group was analyzed using linear regression. Results Two groups′ average PBMD were (1. 8 ± 0. 1)μg/kg and (1. 4 ± 0. 2)μg/kg,compared with 1. 6 μg/kg dosage,the differences were significant (P<0. 05,P <0. 01). There were significant differences between the two groups (P <0. 01). In subtotal-resection group,there was no significant difference in the replacement dosage between male patients and female patients,and replacement therapy dosages were highly correlated with body weight. Conclusion Replace-ment therapy dosage of patients with postoperative hypothyroidism should be formulated according to the amount of re-sidual thyroid and sex instead of 1. 6 μg/kg.