Background: The 2015 American Thyroid Association guidelines recommend the maintenance of serum thyroid stimulating hormone (TSH) levels ≤2 mIU/L in patients with low-risk papillary thyroid carcinoma (PTC) who underwent lobectomy; however, the evidence is insufficient. We investigated the association between maintaining the TSH status at ≤2 mIU/L and tumor recurrence in patients with low-risk PTC who underwent lobectomy through a 5-year landmark analysis.Methods: Between 2010 and 2016, 662 patients with low-risk PTC were included. The postoperative TSH status was determined using the ‘TSH > 2 ratio’, which was calculated using the TSH test results during the 5-year follow-up. The optimal cutoff value of ‘TSH > 2 ratio’ for tumor recurrence was determined using a receiver operating characteristic curve analysis. Recurrence-free survival (RFS) was compared between the groups using Kaplan–Meier and Cox proportional hazard regression analyses.Results: Patients with ‘TSH > 2 ratio’ > 0.1833 (n= 498) had a worse RFS outcome compared to patients with ‘TSH > 2 ratio’ ≤ 0.1833 (n= 164;p< 0.001). ‘TSH > 2 ratio’ > 0.1833 was a significant risk factor for tumor recurrence after the 5-year landmark (hazard ratio: 4.795, 95% confidence interval: 2.102–10.937,p< 0.001).Conclusions: Maintaining TSH levels ≤ 2 mIU/L below a certain percentage among the total TSH tests during the 5-year follow-up period has a negative impact on tumor recurrence.
背景：2015年美国甲状腺协会指南建议，对接受腺叶切除术的低风险甲状腺乳头状癌（PTC）患者，应维持血清促甲状腺激素（TSH）水平≤2 mIU/L；然而，相关证据尚不充分。我们通过一项为期5年的界标分析，研究了在接受腺叶切除术的低风险PTC患者中，维持TSH状态≤2 mIU/L与肿瘤复发之间的关联。 方法：研究纳入了2010年至2016年间的662例低风险PTC患者。术后TSH状态通过“TSH > 2比率”来确定，该比率是利用5年随访期间的TSH检测结果计算得出的。通过受试者工作特征曲线分析确定了“TSH > 2比率”预测肿瘤复发的最佳截断值。采用Kaplan-Meier法和Cox比例风险回归分析比较了各组间的无复发生存期。 结果：与“TSH > 2比率”≤ 0.1833的患者（n=164）相比，“TSH > 2比率”> 0.1833的患者（n=498）具有更差的无复发生存期（p<0.001）。“TSH > 2比率”> 0.1833是5年界标后肿瘤复发的重要危险因素（风险比：4.795，95%置信区间：2.102–10.937，p<0.001）。 结论：在5年随访期间，总TSH检测中维持TSH水平≤2 mIU/L的比例低于某一特定阈值，会对肿瘤复发产生负面影响。
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