Abstract：
OBJECTIVE: The incidences of hypo(para)thyroidism were assessed prospectively in 137 consecutive patients with laryngeal (84.7%) or hypopharyngeal (15.3%) carcinoma who were treated with surgery and/or radiotherapy between 2004 and 2006.
METHODS: Laboratory studies were performed in patients before primary or salvage treatment of a laryngeal or hypopharyngeal carcinoma and were repeated 6, 12, 18 and 24months after treatment. All patients were evaluated for the development of hypo(para)thyroidism, and the presence of autoantibodies. The association of hypothyroidism was analyzed against several patient parameters including tumor and treatment characteristics.
RESULTS: The incidence of hypothyroidism following treatment of laryngeal and hypopharyngeal carcinoma was 47.4%: 27.7% subclinical hypothyroidism and 19.7% clinical hypothyroidism. The median time to develop hypothyroidism was 10months. The incidence of hypoparathyroidism was 7.3%. Univariate analysis showed that patients with laryngectomy, hemithyroidectomy, neck dissection, paratracheal lymph node dissection and radiotherapy had a higher risk of developing hypothyroidism. Multivariate analysis showed laryngectomy, hemithyroidectomy, neck dissection and age to be predictive factors for the development of hypothyroidism. The combination of surgery and radiotherapy increased this risk. Hemithyroidectomy was the most important risk factor.
CONCLUSIONS: The incidence rate of hypothyroidism after treatment for laryngeal or hypopharyngeal cancer in this largest prospective study is high (47.4%), especially after combination treatment. Based on the intervals between treatment and the development of hypothyroidism, thyroid testing before treatment, every 3months during the first year, every 6months the second year and annually thereafter is recommended as screening procedure.
METHODS: Laboratory studies were performed in patients before primary or salvage treatment of a laryngeal or hypopharyngeal carcinoma and were repeated 6, 12, 18 and 24months after treatment. All patients were evaluated for the development of hypo(para)thyroidism, and the presence of autoantibodies. The association of hypothyroidism was analyzed against several patient parameters including tumor and treatment characteristics.
RESULTS: The incidence of hypothyroidism following treatment of laryngeal and hypopharyngeal carcinoma was 47.4%: 27.7% subclinical hypothyroidism and 19.7% clinical hypothyroidism. The median time to develop hypothyroidism was 10months. The incidence of hypoparathyroidism was 7.3%. Univariate analysis showed that patients with laryngectomy, hemithyroidectomy, neck dissection, paratracheal lymph node dissection and radiotherapy had a higher risk of developing hypothyroidism. Multivariate analysis showed laryngectomy, hemithyroidectomy, neck dissection and age to be predictive factors for the development of hypothyroidism. The combination of surgery and radiotherapy increased this risk. Hemithyroidectomy was the most important risk factor.
CONCLUSIONS: The incidence rate of hypothyroidism after treatment for laryngeal or hypopharyngeal cancer in this largest prospective study is high (47.4%), especially after combination treatment. Based on the intervals between treatment and the development of hypothyroidism, thyroid testing before treatment, every 3months during the first year, every 6months the second year and annually thereafter is recommended as screening procedure.
摘要：
目的：前瞻性地评估了在2004年至2006年期间接受手术和/或放疗的137例连续喉癌（84.7%）或下咽癌（15.3%）患者的甲状腺功能减退（副）发生率。
方法：在喉癌或下咽癌的初次或挽救性治疗之前对患者进行了实验室研究，并在治疗后6、12、18和24个月重复。所有患者均评估甲状腺功能减退（副）的发展，和自身抗体的存在。针对包括肿瘤和治疗特征在内的多个患者参数分析了甲状腺功能减退的关联。
结果：喉癌和下咽癌治疗后甲状腺功能减退的发生率为47.4％：27.7％的亚临床甲状腺功能减退和19.7％的临床甲状腺功能减退。发生甲状腺功能减退症的中位时间为10个月。甲状旁腺功能减退的发生率为7.3%。单因素分析显示,喉切除术患者,半甲状腺切除术,颈淋巴结清扫术,气管旁淋巴结清扫术和放疗发生甲状腺功能减退症的风险较高.多因素分析显示喉切除术，半甲状腺切除术,颈淋巴结清扫术和年龄是甲状腺功能减退症发展的预测因素。手术和放疗的结合增加了这种风险。甲状腺切除术是最重要的危险因素。
结论：在这项最大的前瞻性研究中，喉癌或下咽癌治疗后甲状腺功能减退的发生率很高（47.4％），尤其是联合治疗后。根据治疗和甲状腺功能减退症发展的间隔，治疗前甲状腺检查，第一年每3个月，建议第二年每6个月一次,此后每年一次作为筛查程序.
方法：在喉癌或下咽癌的初次或挽救性治疗之前对患者进行了实验室研究，并在治疗后6、12、18和24个月重复。所有患者均评估甲状腺功能减退（副）的发展，和自身抗体的存在。针对包括肿瘤和治疗特征在内的多个患者参数分析了甲状腺功能减退的关联。
结果：喉癌和下咽癌治疗后甲状腺功能减退的发生率为47.4％：27.7％的亚临床甲状腺功能减退和19.7％的临床甲状腺功能减退。发生甲状腺功能减退症的中位时间为10个月。甲状旁腺功能减退的发生率为7.3%。单因素分析显示,喉切除术患者,半甲状腺切除术,颈淋巴结清扫术,气管旁淋巴结清扫术和放疗发生甲状腺功能减退症的风险较高.多因素分析显示喉切除术，半甲状腺切除术,颈淋巴结清扫术和年龄是甲状腺功能减退症发展的预测因素。手术和放疗的结合增加了这种风险。甲状腺切除术是最重要的危险因素。
结论：在这项最大的前瞻性研究中，喉癌或下咽癌治疗后甲状腺功能减退的发生率很高（47.4％），尤其是联合治疗后。根据治疗和甲状腺功能减退症发展的间隔，治疗前甲状腺检查，第一年每3个月，建议第二年每6个月一次,此后每年一次作为筛查程序.
