Tiny steps towards a fuller understanding of thyroid issues and treatment.
The final paragraph of the conclusion says:
Several metabolite abnormalities were attenuated in the L groups and aggravated in the T groups. This suggests that patients with metabolic disorders may have worsening symptoms after total thyroidectomy. Overall, selecting one of the two mentioned surgical methods for patients with PTC should not only be based on the tumor conditions but also on the potential consequences of metabolic variations. Total thyroidectomy reversed some highly increased metabolites but simultaneously increased the accumulation of other metabolites due to the loss of thyroid function compared with unilateral thyroidectomy. Total thyroidectomy prevented tumor recurrence; however, the metabolic disturbance caused by thyroid hormone deficiency should be prevented in advance of this treatment.
NMR-based metabolomics to select a surgical method for treating papillary thyroid carcinoma
Bo Wang1
Li-Yong Zhang1
Si-Si Wang1
Ying-Hong Yang1
Wen-Xin Zhao1 *
1Fujian Medical University Union Hospital, Fuzhou, PR, China
ABSTRACT
OBJECTIVE:
This study aims to investigate differences in the metabolomic profiles of patients who received different surgeries for papillary thyroid carcinoma (PTC).
METHODS:
Two surgical methods, i.e., unilateral and total thyroidectomy, were employed according to different disease conditions. Sera from patients who were treated with levothyroxine sodium tablets before and after surgery was analyzed with a Bruker 500 Hz nuclear magnetic resonance (NMR) spectrometer. Data were analyzed via principal component analysis (PCA) and partial least squares discriminate analysis (PLS-DA) with SIMCA-P+ 11.0 software, and metabolites were obtained and compared. The first and second principal components were selected from PCA, PLS-DA, and orthogonal partial least squares discriminate analysis (OPLS-DA). A p-value less than 0.05 was considered statistically significant.
RESULTS:
There were significant differences in serum metabolomics before and after surgery. Compared with unilateral thyroidectomy, total thyroidectomy reversed some highly increased metabolite levels (e.g., taurine and betaine). More significant variations in abnormal metabolites were noted after total thyroidectomy than after unilateral thyroidectomy (e.g., alanine, choline, hippurate, and formic acid).
CONCLUSIONS:
The choice of surgical method for PTC patients should be based not only on the tumor condition but also on the potential consequences of metabolic variations. Total thyroidectomy reversed some increased metabolite levels but led to accumulation of some other metabolites due to the loss of thyroid function; thus, metabolic disturbances caused by thyroid hormone deficiency should be prevented in advance.
Key words: Thyroid Papillary Carcinoma; Metabolomics; Principal Component Analysis; Total Thyroidectomy; Unilateral Thyroidectomy
Thanks for posting helvella. I think people who've had thyroid cancer or thyroid gland removed will welcome some information. I thought this sentence would prove why many feel very bad after surgery as the specialists don't seem to be aware that patients suffer.:
"This suggests that patients with metabolic disorders may have worsening symptoms after total thyroidectomy. "
I see it as measuring everything in sight (in this case, many of the amino acids plus some other substances) and seeing how they change. Specifically the substances that are related to metabolism.
In a car, we see measurements of levels such as water, oil, antifreeze, battery acid, and gases - air mass intake, nitrogen oxides, carbon dioxide, etc. If any one of those parameters appears odd, we suspect a problem. Combinations can point quite accurately at where that problem lies. Fixing should see them all return to their pre-problem state. Further, there will be differences between cars - one might see a slightly different pattern of changes to another because they are differently designed.
Thank you helvella , that does help me understand. Our bodies are wonderful , like a car, when working well. Doesn’t take much in either to be a problem.
Disappointingly the meat of this paper is the handful of sentences that were in the abstract. Someone else quoted part of this, but the but that really excited me, as a TT patient who hasn't got anywhere near better, was:
"This suggests that patients with metabolic disorders may have worsening symptoms after total thyroidectomy. Overall, selecting one of the two mentioned surgical methods for patients with PTC should not only be based on the tumor conditions but also on the potential consequences of metabolic variations.... Total thyroidectomy prevented tumor recurrence; however, the metabolic disturbance caused by thyroid hormone deficiency should be prevented in advance of this treatment"
These lines suggest that the paper will discuss what can be done. Tantalisingly, it suggests there is some treatment that could be given before the surgery that would sort everything out. But unfortunately the paragraphs these come from are at the very end of the paper, and they don't suggest anything about treatment
I do really like how this paper takes metabolic consequences and problems seriously (this translates into quality of life after surgery, but sounds much more serious and objective), and places them alongside the cancer as significant in treatment.
It's also got some great sections in the discussion where it explains what these chemicals actually mean in terms of how glucose is being used in the body and energy created. I was a little disappointed as I hoped the ending would suggest we could just supplement some of these things. But I THINK they are using these chemicals more as markers of how the energy system of the body is working. This plays into my long held belief that I need to understand Kreb's cycle in order to understand my illness In the paper this is mentioned as the tricarboxylic acid cycle.
I also really liked this sentence of the discussion: "Thyroid surgery can trigger endocrine and metabolic disorders and induce organism-related metabolic disorders."
Just very straightforwardly mentioning something that we already kind of know as patients, and giving it full legitimacy. Unfortunately this statement doesn't even get a reference, they're so casual in their acceptance that its true!
I've also had ongoing problems, as many of us do, talking to friends, family, acquaintances about my illness and why I can't do certain things. Last weekend I went along to an event with people I used to volunteer with and lots of their new colleagues. I was walking with a stick and napping a lot, so of course I had to have LOADS of conversations about what's wrong with me. After the weekend I thought of a sentence I should have used! "My body can't make energy properly". It's really descriptive for people who know nothing, and avoids using the words 'thyroid', or 'thyroid cancer' which I don't like to do because I'm hyper aware that doctors, nurses and other people ignorantly in the know may be thinking "That's the good cancer, thyroid illness is trivially solved", and all that nasty stuff!
It's great to have a paper legitimising that kind of language, and the fact that actually that is central to our condition. It's not even 'a deficiency of T3', it's actually a damaged metabolism that's lost a regulatory organ with all the complexity that implies.
I wanted to go back and cut and paste the whole section of the discussion that talks about krebbs cycle and what we can know from increased lactic acid, etc. But on a reread it's a lot woollier than I thought. There are also a few bits suggesting a low TSH is the culprit. It very much tails off at the end, with most of the space given to the partial thyroidectomy group, and one tiny paragraph at the end summing up the whole TT group, even though they had more extreme changes in metabolites.
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In the paper this is mentioned as the tricarboxylic acid cycle. 
That means a lot coming from someone I admire like you! 
Total thyroidectomy soon...
T3 after completion thyroidectomy
Is thyroid cancer overdiagnosed and overtreated?
