Research of relationship between thyroid-stimulating hormone level after surgery and hypercholesterolemia in female patients with differentiated thyroid cancer
-
摘要: 目的 评估甲状腺全切除术后接受左旋甲状腺素治疗的女性分化型甲状腺癌(DTC)患者术后促甲状腺素(TSH)、血清总胆固醇(TC)水平的变化和高胆固醇血症发生风险。方法 回顾性分析手术治疗的女性DTC患者，收集随访时TSH结果并根据其水平分为 < 0.03 mIU/L、0.03~0.29 mIU/L、0.30~4.20 mIU/L和>4.20 mIU/L四组，比较手术前后TC水平变化，并分析高胆固醇血症的发生情况。结果 术后TSH水平较低组术前TC水平高于TSH较高组。与术前水平相比，术后TSH水平为0.03~0.29 mIU/L的患者TC水平保持不变，TSH水平 < 0.03 mIU/L的患者TC下降，TSH水平>0.30 mIU/L的患者术后TC水平明显升高。手术前后TC变化值与随访时TSH水平显著正相关。TSH 0.30~4.20 mIU/L组TC边缘升高和高胆固醇血症发生率分别为TSH 0.03~0.29 mIU/L组的1.16倍和1.91倍；TSH >4.20 mIU/L组TC边缘升高和高胆固醇血症发生率分别为TSH 0.03~0.29 mIU/L组的1.29倍和3倍。TSH升高与高胆固醇血症发生率上升一致(趋势性检验P=0.003)。结论 女性DTC患者术后用左旋甲状腺素维持TSH水平时，应注意由于替代不足而导致的高胆固醇血症风险。Abstract: Objective To evaluate changes of postoperative thyroid-stimulating hormone(TSH) and total cholesterol(TC) levels in serum, and to analyze the risk of hypercholesterolemia in female patients with differentiated thyroid cancer(DTC) receiving levothyroxine after total thyroidectomy.Method Female patients with DTC in the first affiliated hospital of hebei north university, who underwent total thyroidectomy, were analyzed retrospectively. All patients were divided into four groups according to follow-up TSH levels: < 0.03 mIU/L, 0.03-0.29 mIU/L, 0.30-4.20 mIU/L and>4.20 mIU/L. Changes in TC levels before and after surgery were compared and the occurrence of hypercholesterolemia was analyzed.Result The lower postoperative TSH level groups had higher preoperative TC levels than the higher TSH level groups. Compared with preoperative level, the TC levels remained unchanged in 0.03-0.29 mIU/L group, but decreased in < 0.03 mIU/L group, and markedly increased in greater than 0.3 mIU/Lgroups with TSH levels after surgery. The preoperative-to-follow-up change in TC levels had positive correlation with follow-up TSH level. Compared with those with TSH levels of 0.03-0.29 mIU/L, the risk of TC marginal elevation and hypercholesterolemia in the patients with TSH of 0.30-4.20 mIU/L was found to be 1.16 times and 1.91 times higher, respectively. For patients with TSH levels of >4.2 mIU/L, the risk of TC marginal elevation and hypercholesterolemia was 1.29 times and 3 times, respectively. The increase in TSH was consistent with the increase in the incidence of hypercholesterolemia (P for trend=0.003).Conclusion Women with DTC who are using levothyroxine to maintain TSH after surgery should be aware of the risk of hypercholesterolemia due to inadequate replacement.
-
Key words:
- thyroid neoplasms /
- levothyroxine /
- hypercholesterolemia /
- metabolic disorders
-
-
表 1 不同血清TSH水平的患者基本资料
参数 < 0.03 mIU/L组(n=38) 0.03~0.29 mIU/L组(n=66) 0.30~4.20 mIU/L组(n=69) >4.20 mIU/L组(n=11) P 手术年龄/岁 50.9±10.7 51.3±9.5 48.1±11.2 48.3±10.7 0.001 随访时间/月 14.7±2.5 15.1±3.3 15.3±2.9 15.0±3.7 0.103 高血压史/例(%) 11(28.9) 27(40.9) 20(29.0) 2(18.2) 0.017 糖尿病史/例(%) 7(18.4) 13(19.7) 13(18.8) 2(18.2) 0.667 吸烟史/例(%) 2(5.3) 3(4.5) 3(4.3) 1(9.1) 0.057 BMI 23.6±2.8 24.0±2.9 23.9±3.3 24.1±3.7 0.093 收缩压/mmHg 123.9±15.1 125.1±14.9 124.1±15.8 123.7±16.7 0.384 空腹血糖/(mmol·L-1) 5.51±1.06 5.62±1.27 5.57±1.18 5.48±1.07 0.082 
下载: 导出CSV
表 2 不同血清TSH水平组手术前后TSH和TC检测统计结果
参数 < 0.03 mIU/L组(n=38) 0.03~0.29 mIU/L组(n=66) 0.30~4.20 mIU/L组(n=69) >4.20 mIU/L组(n=11) P 术前TSH/(mIU·L-1) 1.92±0.96 1.91±0.99 1.87±1.02 1.93±1.03 0.583 术前TC/(mg·dL-1) 184.65±27.62 184.13±27.28 178.42±26.96 177.32±27.44 0.031 术后TSH/(mIU·L-1) 0.02±0 0.16±0.08 1.84±0.68 4.73±0.37 < 0.001 术后TC/(mg·dL-1) 181.41±29.37 184.28±30.75 191.31±31.24 193.47±32.08 < 0.001 △TC/(mg·dL-1) -3.24±28.56 0.15±27.98 12.89±29.42 16.15±28.83 < 0.001
下载: 导出CSV
表 3 △TC与随访时TSH水平相关性分析(n=184)
模型1 模型2 模型3 β值 6.39 5.21 5.21 P值 < 0.001 < 0.001 < 0.001 模型1：调整前；模型2：经年龄、术前TC水平和高血压史调整后；模型3：进一步调整随访时间、糖尿病史、吸烟史、BMI、收缩压和空腹血糖。
下载: 导出CSV
表 4 不同血清TSH水平的患者术后高胆固醇血症发生情况统计
例(%) 参数 < 0.03 mIU/L组(n=38) 0.03~0.29 mIU/L组(n=66) 0.30~4.20 mIU/L组(n=69) >4.20 mIU/L组(n=11) P < 200 28(73.7) 46(69.7) 40(58.0) 5(45.5) < 0.001 200~219 7(18.4) 14(21.2) 17(24.6) 3(27.3) 0.005 ≥220 3(7.9) 6(9.1) 12(17.4) 3(27.3) < 0.001
下载: 导出CSV
表 5 Logistics回归分析不同组别术后高胆固醇血症发生情况与TSH相关性
TSH/
(mIU·L-1)例数 TC 200~219 mg/dL TC≥220 mg/dL 例数 OR(95%CI) P 趋势P值 例数 OR(95%CI) P 趋势P值 模型1 < 0.03 38 7 0.73(0.52~1.01) 0.065 3 0.93(0.44~2.17) 0.782 0.03~0.29 66 14 1(Ref) 0.074 6 1(Ref) 0.002 0.30~4.20 69 17 1.35(0.89~1.96) 0.126 12 3.03(1.36~6.82) 0.006 >4.20 11 3 1.71(0.97~3.02) 0.068 3 3.48(1.15~10.31) 0.03 模型2 < 0.03 38 7 0.69(0.48~1.04) 0.052 3 0.87(0.40-2.11) 0.625 0.03~0.29 66 14 1(Ref) 0.002 6 1(Ref) < 0.001 0.30~4.20 69 17 1.89(1.21~2.93) 0.006 12 4.98(2.11~11.83) < 0.001 >4.20 11 3 2.69(1.43~5.05) 0.003 3 6.28(1.93~20.46) 0.003 模型3 < 0.03 38 7 0.68(0.50~1.03) 0.051 3 0.97(0.43~2.26) 0.839 0.03~0.29 66 14 1(Ref) < 0.001 6 1(Ref) < 0.001 0.30~4.20 69 17 1.92(1.25~3.02) 0.003 12 5.14(2.17~12.17) < 0.001 >4.20 11 3 2.91(1.52~5.68) 0.001 3 7.03(2.19~23.07) < 0.001
下载: 导出CSV
-
[1] Santhanam P, Ladenson PW. Surveillance for differentiated thyroid cancer recurrence[J]. Endocrinol Metab Clin North Am, 2019, 48(1): 239-252. doi: 10.1016/j.ecl.2018.11.008
[2] Lin SY, Lin CL, Chen HT, et al. Risk of osteoporosis in thyroid cancer patients using levothyroxine: a population-based study[J]. Curr Med Res Opin, 2018, 34(5): 805-812. doi: 10.1080/03007995.2017.1378174
[3] 李雪. 不同性别的DTC患者甲状腺功能水平与血脂水平的关系[C]. 天津医科大学, 2016.
[4] 程翔, 苏冠华. 血脂领域临床研究新进展[J]. 临床心血管病杂志, 2016, 32(9): 866-867. https://www.cnki.com.cn/Article/CJFDTOTAL-LCXB201609001.htm
[5] 李龙山, 孙鹏飞. 分化型甲状腺癌治疗的现状和进展[J]. 中华普通外科学文献: 电子版, 2017, 11(3): 208-212. doi: 10.3877/cma.j.issn.1674-0793.2017.03.019
[6] Demers LM, Spencer CA. Laboratory medicine practice guidelines: laboratory support for the diagnosis and monitoring of thyroid disease[J]. Clin Endocrinol(Oxf), 2003, 58(2): 138-140. doi: 10.1046/j.1365-2265.2003.01681.x
[7] Ito M, Miyauchi A, Hisakado M, et al. Biochemical markers reflecting thyroid function in athyreotic patients on levothyroxine monotherapy[J]. Thyroid, 2017, 27(4): 484-490. doi: 10.1089/thy.2016.0426
[8] Ito M, Miyauchi A, Morita S, et al. TSH-suppressive doses of levothyroxine are required to achieve preoperative native serumtriiodothyronine levels in patients who have undergone total thyroidectomy[J]. Eur J Endocrinol, 2012, 167(3): 373-378. doi: 10.1530/EJE-11-1029
[9] Peterson SJ, Mcaninch EA, Bianco AC. Is a normal TSH synonymous with "euthyroidism"in levothyroxine monotherapy?[J]. J Clin Endocrinol Metab, 2016, 101(12): 4964-4973. doi: 10.1210/jc.2016-2660
[10] McAninch EA, Rajan KB, Miller CH. Systemic thyroid hormone status during levothyroxine therapy in hypothyroidism: a systematic review and Meta-analysis[J]. J Clin Endocrinol Metab, 2018, 103(12): 4533-4542.
[11] Biondi B. Persistent dyslipidemia in patients with hypothyroidism: a good marker for personalized replacement therapy?[J]. J Clin Endocrinol Metab, 2019, 104(2): 624-627. doi: 10.1210/jc.2018-02302
[12] Sharifi M, Futema M, Nair D, et al. Polygenic hypercholesterolemia and cardiovascular disease Risk[J]. Curr Cardiol Rep, 2019, 21(6): 43-43. doi: 10.1007/s11886-019-1130-z
[13] Duntas LH, Brenta G. Thyroid hormones: a potential ally to LDL-cholesterol-lowering agents[J]. Hormones(Athens), 2016, 15(4): 500-510.
[14] 宣丽萍, 杨振兴, 于媚, 等. 亚临床甲状腺功能减退症患者促甲状腺素与脑血管病危险因素关系的研究[J]. 中华全科医学, 2018, 16(12): 60-63. https://www.cnki.com.cn/Article/CJFDTOTAL-SYQY201812016.htm
-