After armour cancer surgery, does the patient that prepares iodine-131 treatment want neck wound to be in after healing stop superior armour le?

2022-07-27 0 By

Patients who are prepared for iodine-131 treatment after thyroid cancer surgery: 1. Some experts suggest that thyroid hormone should be supplemented after surgery (such as euthyroxine), and euthyroxine should be stopped after the surgical wound is healed.The rationale for this recommendation is that if euthyroxine is not immediately supplemented after total thyroidectomy, the patient’s hypothyroidism (hypothyroidism) may affect neck wound healing.2. Other experts suggested that eutroxol should be temporarily removed after surgery and iodine-131 should be directly administered after 2-4 weeks of low-iodine diet.The reason for this recommendation — in clinical work, there is no delay in wound healing due to patients not receiving eumetra immediately after surgery.In addition, there are three benefits: (1) Thyroid cancer treatment trilogy — “operation + iodine-131 treatment +TSH inhibition treatment” in one go, shorten the sick leave time of patients;② Reduce the adjustment of eucloxacin dosage once;③ Reduce one return visit.Radically different recommendations, how should patients choose?Here’s an analysis with me to see whose advice makes more sense.There is controversy over whether hypothyroidism affects wound healing, whether in animal or clinical trials.In mice, testing for expression of hydroxyproline (a major component of collagen), or collagen, or keratin genes in surgical wounds suggests that hypothyroidism affects wound healing in mice.However, the pig skin experiment, which was very similar to human skin, showed a contrary conclusion: there was no significant difference in wound tensile strength and skin necrosis rate between pigs with severe hypothyroidism after total thyroidectomy and pigs with normal thyroid function, and simple hypothyroidism did not affect wound healing.A simulated surgical wound in the abdomen of a mouse 10 weeks after total thyroidectomy (left) (right) (Image from Nihon Ika Daigaku Zasshi. 1999 Jun;66(3):176-80.) Similarly, clinical studies in patients with hypothyroidism have not been consistent.Studies by Vakharia et al. suggest that hypothyroidism leads to an increased risk of wound nonhealing.However, Ladenson et al. showed no difference in wound healing between hypothyroidism patients and patients with normal thyroid function.Although the existing research has failed to give positive answers, but by analyzing the literature more deeply, maybe can give us some helpful enlightenment: animal experiment by feed the animals overdosage anti-thyroid drugs inhibit thyroid function for months, or complete resection of the thyroid 6-10 weeks later, began to experiment in surgical wound healing.At this point, the animal’s thyroid hormone levels are in an extreme state of severe hypothyroidism, which is completely different from a real clinical scenario.The thyroid function of the patient was normal before surgery. After the thyroidectomy, the retained thyroid hormone in the blood circulation of the patient gradually decreased with the daily consumption of the body.It takes about 7 days for thyroxine (T4) to be reduced by half in the body.As a result, it takes at least two weeks for thyroid hormone levels to drop to very low levels.Will the patient’s wounds heal with a two-week buffer?To answer that question, let’s take a look at some of the basics of wound healing.Wound healing is divided into four stages: hemostasis (seconds to minutes) → inflammation (3-5 days) → proliferation (4 to 14 days) → remodeling (8 days to 1 year).The proliferation stage is the most critical period for wound healing — reepithelialization, angiogenesis, granulation tissue formation and collagen deposition.Therefore, we can speculate that with a 2-week buffer, relatively mild hypothyroidism may have no significant effect on the proliferative period of wound healing, which may be why we have not observed any effect on wound healing in patients who were prepared for iodine-131 therapy immediately after surgery.After thyroid cancer operation, how should the patient choose?Patients should consider the choice and arrangement of appropriate iodine-131 treatment plan according to their life, study and work and other comprehensive factors, including immediate preparation of iodine-131 treatment after surgery or delayed preparation of iodine-131 treatment after surgery.– Pay attention to details, analyze experts’ opinions and answer patients’ doubts.Zhang Chun Reference [1] Kowalewski K,Yong S. Hydroxyproline in healing dermal wounds of normal and hypothyroid rats. Acta Endocrinol (Copenh). 1967 Jan;54(1):1-7.[2] Ladenson PW, Levin AA, Ridgway EC, et al. Complications of surgery in hypothyroid patients. Am J Med. 1984 Aug;77(2):261-6.[3] Cannon CR. Hypothyroidism in head and neck cancer patients: experimental and clinical observations. Laryngoscope. 1994 Nov;104(11 Pt 2 Suppl 66):1-21.[4] Natori J, Shimizu K, Nagahama M, et al. The influence of hypothyroidism on wound healing. An experimental study. Nihon Ika Daigaku Zasshi. 1999 Jun;66(3):176-80.[5] Safer JD, Crawford TM, Holick MF. A role for thyroid hormone in wound healing through keratin gene expression. Endocrinology. 2004 May;145(5):2357-61.[6] Janis JE, Kwon RK, Lalonde DH. A practical guide to wound healing. Plast Reconstr Surg. 2010 Jun;125(6):230e-244e.[7] Janis JE, Harrison B. Wound Healing: Part I. Basic Science. Plast Reconstr Surg. 2016 Sep;138(3 Suppl):9S-17S.[8] Vakharia RM, Vakharia AM, Ameri B, et al. Hypothyroidism increases 90-day postoperative complications in patients undergoing primary single level anterior cervical disectomy and fusion: a matched control analysis. J Spine Surg. 2018 Jun;4(2):274-280.[9] Zhang GY, Langan EA, Meier NT, et al. Thyroxine (T4) may promote re-epithelialisation and angiogenesis in wounded human skin ex vivo. PLoS One. 2019 Mar 29;14(3): e0212659.