专题研究(Monographic Study)

分化型甲状腺癌术后131I治疗对甲状旁腺辐射损伤作用

Published at: 2016年第25卷第11期

吴红伟 1 , 沈丰 1 , 孙少华 1 , 胡洪生 1 , 周文波 1
1 湖北医药学院附属东风医院 甲状腺外科,湖北 十堰 442000
通讯作者 文波 周 Email: zwbmail@163.com
DOI: 10.3978/j.issn.1005-6947.10.3978/j.issn.1005-6947.2016.11.010
基金:

摘要

目的:探讨分化型甲状腺癌术后131I治疗对甲状旁腺的直接辐射损伤作用及其对甲状旁腺功能的影响,以及131I的治疗时机。方法:回顾性分析2013年1月―2015年2月在甲状腺外科第一次行131I清甲治疗的281例甲状腺乳头状癌患者的临床资料。依据131I治疗前甲状旁腺激素水平分为甲状旁腺功能正常者238例和甲状旁腺功能轻度低下者43例。检测并分析患者术后第1、6天与131I治疗前、131I治疗后1周、3个月的血清钙水平和血清甲状旁腺激素水平。结果:所有患者131I治疗前均无低钙血症的临床表现。术后甲状旁腺功能正常患者不同时间点的血清钙水平整体差异有统计学意义(F=6.912,P<0.05),术后第1天血清钙水平最低(P<0.05),其余4次时间点间血清钙水平差异无统计学意义(P>0.05);不同时间点甲状旁腺激素水平整体差异有统计学意义(F=16.808,P<0.05),术后第1天水平最低,131I治疗前升高,131I治疗后1周再次下降,131I治疗后3个月再次升高。术后甲状旁腺功能轻度低下患者131I治疗后于平均术后第7.5天出现不同程度的低钙血症;不同时间点的血清钙水平整体差异有统计学意义(F=37.710,P<0.05),术后第1天和131I治疗1周后血清钙水平最低;不同时间甲状旁腺激素水平整体差异有统计学意义(F=29.082,P<0.05),术后第1天水平最低,131I治疗前升高,131I治疗后1周再次下降,且接近术后第1天水平(P>0.05),131I治疗后3个月再次升高,且均值达到正常值范围。结论:131I清甲治疗对甲状旁腺存在直接辐射损伤,可引起甲状旁腺功能减退,加重甲状旁腺功能低下。分化型甲状腺癌术后若合并甲状旁腺功能低下,建议等到甲状旁腺激素完全恢复正常后再行131I清甲治疗。


Radiation damage effect of 131I therapy to parathyroid glands after surgery for differentiated thyroid carcinoma

Abstract

Objective: To investigate the direct radiation damage to the parathyroid glands and impact on the function of parathyroid glands due to 131I therapy after surgery for differentiated thyroid carcinoma, as well as the timing for postoperative 131I therapy. Methods: The clinical data of 281 patients with differentiated thyroid carcinoma undergoing the first postoperative 131I thyroid remnant ablation from January 2013 to February 2015 were retrospectively analyzed. According to parathyroid hormone level before 131I treatment, 238 patients had normal function of parathyroid glands and 43 patients had mild hypoparathyroidism. The serum levels of calcium and parathyroid hormone of the patients on postoperative day (POD) 1 and 6, as well as before, 1 week and 3 months after 131I therapy were determined and analyzed. Results: All patients had no manifestations of hypocalcemia before 131I therapy. In patients with postoperative normal function of parathyroid glands, the overall difference in serum calcium level was statistically significant among different time points (F=6.912, P<0.05), and the serum calcium showed the lowest level on POD 1 (P<0.05), while it showed no statistical difference among the other 4 time points (P>0.05); the overall difference in serum parathyroid hormone level was statistically significant among different time points (F=16.808, P<0.05), and the parathyroid hormone reached the lowest level on POD 1, then increased before 131I therapy, and reduced again 1 week after 131I therapy, and then, increased again 3 months after 131I therapy. In patients with postoperative mild hypoparathyroidism, hypocalcemia occurred with different degrees on average POD 7.5 d after 131I therapy; the overall difference in serum calcium level was statistically significant among different time points (F=37.710, P<0.05), and the serum calcium showed the lowest level on POD 1 and 1 week after 131I therapy; the overall difference in serum parathyroid hormone level was statistically significant among different time points (F=29.082, P<0.05), the serum parathyroid hormone showed the lowest level on POD 1, then increased before 131I therapy, and reduced again one week after 131I therapy, which approached the level on POD1 (P>0.05), and rose again 3 months after 131I therapy, which averagely reached the normal range. Conclusion: 131I thyroid remnant ablation exerts direct radiation damage to parathyroid glands, may cause hypoparathyroidism and aggravate the existing hypoparathyroidism. For patients with hypoparathyroidism after surgery for differentiated thyroid carcinoma, 131I thyroid remnant ablation is recommended to be delayed until the parathyroid hormone has completely recovered to normal level.


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引用

引用本文: 红伟 吴, 丰 沈, 少华 孙, 洪生 胡, 文波 周. 分化型甲状腺癌术后131I治疗对甲状旁腺辐射损伤作用[J]. 中国普通外科杂志, 2016, 25(11): 1580-1584.
Cite this article as: WU Hongwei, SHEN Feng, SUN Shaohua, HU Hongsheng, ZHOU Wenbo . Radiation damage effect of 131I therapy to parathyroid glands after surgery for differentiated thyroid carcinoma [J]. Chin J Gen Surg, 2016, 25(11): 1580-1584.