QUOTE(Joliuke @ 2007 01 18, 22:01)
O kas dėl TTH tai tikrai mums geriau kai jis per didelis, negu per mažas
va, cia daug informacijos apie TTH (TSH), atsiprasau, kad angliskai, bet cia nesunku suprasti ir nelabai gerai mokancioms. Paspalvinau pagrindine info. Jeigu as teisingai supratau, tai mums geriau - mazesnis TTH.
aThyrotropin-suppressive therapy
Rationale and recommendation:
F Pacini and others EUROPEAN JOURNAL OF ENDOCRINOLOGY (2006) 154
The role of TSH-suppressive therapy after initial
treatment is twofold: the first aim is to correct the
hypothyroidism using a dosage appropriate to
achieve normal blood levels of thyroid hormone.
The second aim is to inhibit the TSH-dependent
growth of residual cancer cells by decreasing the
serum TSH level to %0.1 mU/l (63, 64). In patients
considered in complete remission at any time during
follow-up, there is no need to suppress endogenous
TSH and thus therapy may be shifted from
suppressive to replacement (65).
LT4 is the drug of choice. The use of T3 has no place in
the long-termtreatment of thyroid cancer patients and
its use is limited to short-term correction of hypothyroidism
or in preparation for a WBS.
Initially, the dose of LT4 should be sufficient to decrease
the serum TSH to %0.1 mU/l. There is no evidence
that pushing the TSH suppression below this level
(0.05 or lower) results in a better outcome. The TSH
level is measured at least 3 months after initiation of
therapy. The daily dose of LT4 is then adjusted by a
decrease or an increase of25 mg/day, and serumTSHis
monitored again 3 months later. When the optimal
dose of LT4 has been achieved, it should not be
modified and serum FT4, FT3 (optionally) and TSH is
monitored every 612 months.
TSH-suppressive therapy (serum TSH %0.1 mU/l) is
mandatory in patients with evidence of persistent
disease (including detectable serum Tg and no other
evidence of disease). In high-risk patients who have
achieved apparent remission after treatment, suppressive
therapy is advised for 35 years. In low-risk
patients, when a cure has been assessed, the risk of
subsequent recurrence is low (!1%) and the dose of
LT4 can be immediately decreased, aiming for a serum
TSH level within the lower part of the normal range
(between 0.5 and 1.0 mU/l) (66).LT4 treatment is best supervised by an endocrinologist
or other member of the multidisciplinary team.
LT4 treatment should be taken once a day, in the
morning on an empty stomach 2030 minutes before
breakfast.
Adverse effects of subclinical thyrotoxicosis secondary
to TSH suppression are represented mainly by cardiac
complications and bone loss (67).Retrospective studies
have shown that these possibilities are limited if the
appropriate dose of LT4 is carefullymonitored, thereby
avoiding elevation of FT4 and FT3.However, in elderly
patients and in patients with known cardiac disease,
TSHsuppression should be avoided.During subclinical
thyrotoxicosis an additional matter of concern is the
evidence that the majority of patients have a
prothrombotic profile (68).
In the event of pregnancy the dose of LT4may require
adjustment, based on to the results of TSH measurements.
In the case of documented stable remission, the
optimal TSH level should be in the low-normal range,
but, if the woman has persistent disease or is at high
risk of recurrence, serum TSH should be kept
suppressed at around 0.1 mU/l.
, geriau rašyk, kad visiškai išsigydo apie 90 procentų, o tai galima pagalvot, kad su skydliaukės ca gyvensim tik 10 metų. Brrrrrrrr.
