NEJM:低危甲状腺癌患者甲状腺切除术后无放射性碘治疗的效果

2022-03-10 MedSci原创 MedSci原创

在接受甲状腺切除术的低风险甲状腺癌患者中,不使用放射性碘的随访策略在3年时功能、结构和生物学事件的发生率方面不劣于放射性碘消融策略。

在接受甲状腺切除术的低风险分化型甲状腺癌患者中,术后使用放射性碘(iodine-131)是有争议的,因为没有明显的益处。

近日,顶级医学期刊NEJM上发表了一篇研究文章,在这项前瞻性、随机、3期试验中,研究人员将接受甲状腺切除术的低风险分化型甲状腺癌患者分配接受消融治疗,术后注射重组人促甲状腺激素后给予放射性碘(1.1GBq)(放射性碘组)或不接受术后放射性碘(无放射性碘组)。

该研究主要目的是评估在没有包括3年功能、结构和生物学异常的复合终点方面,无放射性碘治疗是否不劣于放射性碘治疗。非劣效性定义为未发生事件的患者百分比的组间差异小于5个百分点,这些事件包括全身扫描中存在需要后续治疗的放射性碘摄取异常灶(仅在放射性碘组)、颈部超声检查发现异常,或甲状腺球蛋白或甲状腺球蛋白抗体水平升高。该研究的次要终点包括事件和分子特征的预后因素。

在随机分组后3年可以评估了730名患者中,无事件的患者百分比在无放射性碘组为95.6%(95%置信区间[CI]为93.0至97.5),在放射性碘组中为95.9%(95%CI为93.3至97.7),差异为-0.3个百分点(双侧90%CI为-2.7至2.2),结果符合非劣效性标准。8名患者的结构或功能异常和23名患者的生物学异常。在甲状腺激素治疗期间,术后血清甲状腺球蛋白水平超过1ng/mL的患者事件发生率更高。发生或未发生事件的患者的分子改变相似。没有报告与治疗相关的不良事件。

由此可见,在接受甲状腺切除术的低风险甲状腺癌患者中,不使用放射性碘的随访策略在3年时功能、结构和生物学事件的发生率方面不劣于放射性碘消融策略。

原始出处:
 
Sophie Leboulleux,et al.Thyroidectomy without Radioiodine in Patients with Low-Risk Thyroid Cancer.NEJM.2022.https://www.nejm.org/doi/full/10.1056/NEJMoa2111953

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    2022-03-10 不能空腹吃早餐

    #学习#学习一下

    0

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    2022-03-10 医者仁者

    #甲状腺癌#患者#甲状腺切除术#是否有必要治疗,确实有争议。

    0

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接受甲状腺切除术的患者可能会出现轻度的体重增加,尤其是年龄较小的患者和甲状腺功能亢进症的患者。

Thyroid:甲状腺切除术后严重抑郁症的发病率增加

由此可见,甲状腺切除术后MDD发生率增加,并持续1-2年。本研究强调了对接受部分或全部甲状腺切除术的患者进行相对长期定期精神病评估的重要性。

JCEM:接受甲状腺切除术的甲状腺癌患者心血管结局

DTC患者发生房颤、CVD、心率加快和左心室质量增重的风险增加。

BMC Anesthesiol:罗哌卡因伤口浸润联合静脉注射氟比洛芬酯的多模式镇痛为甲状腺根治术后患者提供了良好的镇痛效果:一项随机对照试验

甲状腺切除术是一种常见的可导致轻微创伤的手术方法。然而,术后疼痛仍然是患者护理中的主要挑战。包含镇痛药和镇痛技术的组合的多模式镇痛在控制术后疼痛方面已变得越来越流行。本研究验证了在甲状腺根治术后罗哌卡因伤口浸润和静脉注射氟比洛芬酯复合镇痛比单剂量曲马多镇痛效果更好的假设。

Am J Med Sci:术前补充维生素D可降低甲状腺全切患者术后低钙血症的发生率

甲状旁腺或血管操作引起的短暂性低钙血症是甲状腺切除术后常见的并发症。考虑到25-羟维生素D(25(OH)D)在止血钙中的作用,研究人员进行了一项随机临床试验,评价了甲状腺切除术患者术前补充维生素D对低

JCEM:甲状腺切除的甲状腺癌患者发生2型糖尿病的风险增加

接受甲状腺切除术的甲状腺癌患者比匹配的对照组更容易患2型糖尿病。左旋甲状腺素剂量与2型糖尿病风险之间存在U形剂量依赖性关系。