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在差异化甲状腺癌中定制TSH抑制:证据,争议和未来的方向
Xinxin Song1, Xin Zhi1, Linxue Qian2
1Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
Endocrine
|April 8, 2025
概括
对差异化甲状腺癌的甲状腺激素抑制疗法具有有争议的益处和风险. 需要个性化策略来平衡治疗结果和潜在的不良影响,特别是在高风险患者中.
科学领域:
- 内分泌学 在内分泌学.
- 在瘤学瘤学.
背景情况:
- 差异化甲状腺癌 (DTC) 管理通常涉及甲状腺激素抑制疗法 (THST).
- 在DTC中THST的治疗益处和风险之间的最佳平衡仍在争论中.
- 个性化治疗策略对于优化患者的治疗结果至关重要.
研究的目的:
- 审查THST在DTC中的有争议的好处和风险.
- 突出了THST对DTC的个性化策略的需要.
- 为了指导未来的研究,优化TSH抑制治疗.
主要方法:
- 在过去10年的DTC中对TSH抑制进行系统的文献搜索.
- 优先考虑随机对照试验 (RCT),大型队列研究和非劣势试验.
- 包括从检索的文章中添加的附加引用.
主要成果:
- 在高风险的DTC中,严格的TSH抑制 (<0.1 mU/L) 的证据有限.
- 由于异质性,对于中等风险的DTC数据是不够的.
- 在低风险的DTC中,一般不建议抑制TSH.
- 过度THST的不良影响包括心血管问题和骨质疏松症.
- 在现实世界中,实现目标TSH水平是具有挑战性的.
结论:
- 目前的证据对2015年ATA指南的TSH目标提供了有限的支持.
- 优化术后TSH管理需要考虑个别因素.
- 未来的研究应该专注于为个性化TSH管理设计好的研究.
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