背景:甲状腺全切除术正在发展成为非恶性甲状腺疾病的治疗选择。因此,理想的甲状腺素替代方法是必要的,以避免这类患者因替代不足和过度而产生的不良影响.
目的:评估最佳甲状腺素剂量与瘦体重(LBM)等潜在变量之间的相关性,体表面积(BSA),体重指数(BMI),体重,年龄,在我们研究所接受良性多结节性甲状腺肿全甲状腺切除术的患者的性别。
方法:在Thrissur政府医学院进行了一项纵向队列研究,印度的三级护理提供者,2018年10月至2019年9月。包括100名因各种良性甲状腺疾病而接受全甲状腺切除术的成年患者。他们最初在出院时给予甲状腺素75µg,每两个月接受一次随访剂量,直到他们连续两次访问达到正常甲状腺状态。在这个阶段评估的变量包括年龄,性别,实际体重,瘦体重,BMI,和生化数据(三碘甲状腺原氨酸(T3),甲状腺素(T4),促甲状腺激素(TSH))。相关性,多元逐步回归,和方差使用EPIINFO7.2.2.6版进行。
结果:最佳甲状腺素剂量的最佳预测因子是BSA(0.923,P<0.01)和LBM(0.921,P<0.01)。体重(0.833,P<0.01)和BMI(0.523,P<0.01)。在我们的研究中,最不显著的因素是患者的年龄(r=0.117,P<0.01)。性别与甲状腺素剂量之间没有显着关联。平均甲状腺素剂量为1.87µg/kg患者体重。
结论:基于BSA或LBM的最佳甲状腺素替代是比单独基于BMI或体重更理想的方法。
BACKGROUND: Total thyroidectomy is evolving as the choice of treatment for non-malignant thyroid conditions. Therefore, an ideal method of thyroxine replacement is necessary to avoid the ill effects of under- and over-replacement in such patients.
OBJECTIVE: To assess the correlation between optimal thyroxine dose and potential variables like lean body mass (LBM), body surface area (
BSA), body mass index (BMI), body weight, age, and sex in patients who underwent total thyroidectomies for benign multinodular goiters in our institute.
METHODS: A longitudinal cohort study was undertaken at the Government Medical College Thrissur, a tertiary care provider in India, between October 2018 and September 2019. One hundred adult patients who underwent a total thyroidectomy for various benign thyroid conditions were included. They were initially given thyroxine 75 µg upon discharge and received follow-up doses every two months until they achieved euthyroid status on two consecutive visits. The variables evaluated at this stage included age, sex, actual body weight, lean body weight, BMI, and biochemical data (triiodothyronine (T3), thyroxine (T4), thyroid-stimulating hormone (TSH)). Correlation, multiple step-wise regression, and variance were carried out using EPI INFO version 7.2.2.6.
RESULTS: The best predictors for optimum thyroxine dose were
BSA (0.923, P < 0.01) and LBM (0.921, P < 0.01), compared with body weight (0.833, P < 0.01) and BMI (0.523, P < 0.01). In our study, the least significant factor was the age of the patient (r = 0.117, P < 0.01). There was no significant association between gender and thyroxine dose. The mean thyroxine dose was 1.87 µg/kg of the patient\'s body weight.
CONCLUSIONS: The optimum thyroxine replacement based on
BSA or LBM is a more ideal method than based on BMI or body weight alone.