Güllü S, Gürses M A, Başkal N, Uysal A R, Kamel A N, Erdoğan G
Department of Endocrinology and Metabolic Diseases, Ankara University Medical School, Turkey.
Endocr J. 1999 Feb;46(1):221-6. doi: 10.1507/endocrj.46.221.
In this study, 35 patients with euthyroid diffuse goiter and 35 patients with euthyroid nodular goiter were treated with Levothyroxine (L-T4) for six months. The aim was to evaluate the efficacy of treatment on thyroid and nodule volumes and to evaluate the correlation between volume changes and thyroglobulin levels. Serum thyroid hormones, TSH, thyroglobulin, thyroid and nodule volumes were measured at the initial visit and after 6 months. Radioactive iodine uptakes of the thyroid gland were evaluated before treatment. The mean decrease of thyroid volume at six months was about 20% (20.4 +/- 8.8 ml vs. 16 +/- 7.9 ml, P<0.001) in patients with diffuse goiter. All patients with diffuse goiter showed some decrement in their goiter sizes. Thyroid nodules, in response to thyroid hormone treatment, showed a variable behavior. A reduction of 50% or more in volume was detected in 31% (11/35) of the patients. 54% of the patients (19/35) showed a 10-49% decrease in nodule volume. Five of the patients were found to be insensitive to the therapy. Their nodule volumes either increased or did not change during therapy. Free T4 and free T3 levels increased and TSH levels decreased with L-T4 treatment in all patient groups. Patients with higher TSH levels (within normal limits) showed more volume reduction in the diffuse goiter group. No uniform correlation was found between volume changes and thyroglobulin levels in either of the patient groups. In conclusion, suppressive thyroxine treatment is effective in reducing the size of the goiter, and nodules and thyroglobulin levels cannot be taken as an indicator of the efficacy of L-T4 therapy.
在本研究中，35例甲状腺功能正常的弥漫性甲状腺肿患者和35例甲状腺功能正常的结节性甲状腺肿患者接受左甲状腺素（L-T4）治疗6个月。目的是评估治疗对甲状腺和结节体积的疗效，并评估体积变化与甲状腺球蛋白水平之间的相关性。在初诊时和6个月后测量血清甲状腺激素、促甲状腺激素（TSH）、甲状腺球蛋白、甲状腺和结节体积。在治疗前评估甲状腺的放射性碘摄取。弥漫性甲状腺肿患者在6个月时甲状腺体积平均减少约20%（20.4±8.8 ml对16±7.9 ml，P<0.001）。所有弥漫性甲状腺肿患者的甲状腺肿大小均有一定程度的减小。甲状腺结节对甲状腺激素治疗的反应表现各异。31%（11/35）的患者结节体积减少50%或更多。54%的患者（19/35）结节体积减少10%-49%。发现5例患者对治疗不敏感。他们的结节体积在治疗期间要么增大，要么没有变化。所有患者组在L-T4治疗后游离T4和游离T3水平升高，TSH水平降低。在弥漫性甲状腺肿组中，TSH水平较高（在正常范围内）的患者甲状腺肿体积减小更明显。在任何一组患者中，均未发现体积变化与甲状腺球蛋白水平之间存在一致的相关性。总之，抑制性甲状腺素治疗在减小甲状腺肿大小方面是有效的，结节和甲状腺球蛋白水平不能作为L-T4治疗疗效的指标。
