Evaluation of Thyroid Hormone Replacement Dosing in Overweight and Obese Patients After a Thyroidectomy.
甲状腺切除术后超重和肥胖患者甲状腺激素替代剂量的评估。
body mass index levothyroxine levothyroxine dosing obese overweight
下载

摘要

                        Background:
                     Initiation of thyroid hormone replacement (THR) after a total thyroidectomy has traditionally relied on the weight of the patient, regardless of the patient's body mass index (BMI). Current literature suggests that THR in obese patients differs from nonobese patients. This can lead to overdosing of levothyroxine (LT4) and delay in achievement of euthyroid state. 
                        Methods:
                     We retrospectively identified patients on THR after total thyroidectomy with a benign postoperative diagnosis. Patients who achieved euthyroidism with THR were included in the analysis. Patient demographic and THR dosing information was collected. Regression analysis was performed to identify appropriate THR dosing at varying BMIs. This study aimed to evaluate the appropriate dosing of THR in overweight and obese patients. 
                        Results:
                     Our cohort consisted of 114 patients achieving euthyroidism while on THR. Mean age was 55 years (range 28-77 years) with 84% females. Of the 114 patients, the number of patients with a BMI less than 25, 25-29, 30-34, 35-39, and greater than 40 were 26 (23%), 33 (29%), 23 (20%), 19 (17%), and 13 (11%), respectively. Of the entire cohort, a mean of 50 weeks elapsed after surgery to achieve euthyroidism, with no significant difference between the BMI categories (p = 0.58). In obese patients (BMI >30), 35% were overdosed with LT4 on initial dosing. The cohort lost a mean of 3 kg until euthyroidism was achieved, with no significant difference in the weight loss based on BMI category (p = 0.61). Patients with a higher BMI did require a higher dose (mcg) of LT4 to achieve euthyroidism (p < 0.01), but the dose was significantly lower in relation to their weight (mcg/kg) (p < 0.01). The LT4 dose required to achieve euthyroidism based on the previously mentioned BMI categories were 1.76, 1.47, 1.42, 1.27, and 1.28 mcg/kg. 
                        Conclusion:
                     The current weight-based dosing of THR inappropriately overdoses overweight and obese patients. A more appropriate formula for THR titration should consider both the weight and BMI of the patient.

译文

背景:
甲状腺全切除术后甲状腺激素替代 (THR) 的启动传统上依赖于患者的体重,而不管患者的体重指数 (BMI)。目前的文献表明肥胖患者的 THR 不同于非肥胖患者。这可能导致左旋甲状腺素 (LT4) 过量,并延迟达到正常甲状腺状态。
方法:
我们回顾性确定了甲状腺全切除术后 THR 上的患者,术后诊断为良性。获得 THR 甲状腺功能正常的患者被纳入分析。收集患者人口统计学和 THR 给药信息。进行回归分析以确定不同 BMIs 下适当的 THR 剂量。本研究旨在评估超重和肥胖患者 THR 的适当剂量。
结果:
我们的队列包括 114 名在 THR 时达到甲状腺功能正常的患者。平均年龄为 55 岁 (28-77 岁),女性为 84%。在 114 名患者中,体重指数小于 25 、 25-29 、 30-34 、 35-39 和大于 40 的患者数量为 26 (23%), 分别为 33 (29%) 、 23 (20%) 、 19 (17%) 和 13 (11%)。在整个队列中,平均在手术后 50 周达到甲状腺功能正常,BMI 类别之间没有显著差异 (p = 0.58)。在肥胖患者 (BMI> 30) 中,35% 的患者在初始剂量时过量服用 LT4。在达到甲状腺功能正常之前,该队列平均减掉了 3 千克,基于 BMI 类别的体重减轻没有显著差异 (p = 0.61)。体重指数较高的患者确实需要较大剂量 (mcg) 的 LT4 来达到甲状腺功能正常 (p <-0.01), 但是剂量与他们的体重 (mcg/kg) 相关显著较低 (p <-0.01)。基于之前提到的 BMI 类别,达到甲状腺功能正常所需的 LT4 剂量分别为 1.76 、 1.47 、 1.42 、 1.27 和 1.28 微克/千克。
结论:
目前基于体重的 THR 剂量不适当地过量服用超重和肥胖患者。一个更合适的 THR 滴定公式应该同时考虑患者的体重和 BMI。

Thyroidectomy

内分泌 手术 治疗方法
概述  :  

甲状腺切除术是涉及外科手术切除全部或部分甲状腺的手术。当患者患有甲状腺癌或甲状腺的某些其他疾病(例如甲状腺功能亢进)或甲状腺肿大时,内分泌或头颈外科医生通常会建议进行甲状腺切除术。其他手术适应症包括美容(甲状腺肿大)或症状性阻塞(导致吞咽或呼吸困难)。 手术类型 ①甲状腺切除术:切除整个峡部和1个叶,适用于仅做过1个叶的良性疾病。 ②甲状腺大部切除术:去除大部分两叶,在一侧或两侧留下4-5克(相当于正常甲状腺的大小)的甲状

thyroidectomy   英 /,θaɪrɒɪ'dektəmɪ/   美 /,θaɪrɔɪ'dɛktəmi/

释    义   n. [外科] 甲状腺切除术

例    句   Objective To explore diagnosis and countermeasure of tracheomalacia in thyroidectomy.目的探讨甲状腺切除术中气管软化的诊断及对策。

请扫描右侧二维码,免费查看词汇专业知识背景