Gordon D L, Flisak M, Fisher S G
Department of Medicine, Loyola University of Chicago, Maywood, Illinois 60153, USA.
J Clin Endocrinol Metab. 1999 Dec;84(12):4566-9. doi: 10.1210/jcem.84.12.6195.
The effectiveness of TSH suppression therapy for thyroid nodules remains controversial. Prior studies have assumed that the fine-needle aspiration biopsy (FNAB), used to confirm a benign condition before the establishment of control and treatment groups, has no effect on nodule volume. Seventeen untreated euthyroid patients with clinical solitary thyroid nodules that were solid (on high-resolution ultrasound) and a colloid goiter (on cytologic examination) had ultrasound measurements of nodule volume before a FNAB, immediately thereafter, and 1 month and 6 months later. Size differences and individual variability at each time period were analyzed. No significant difference in mean thyroid nodule volume was present at any point after the FNAB; however, the changes in nodule volume were quite marked and bidirectional among patients masking the cumulative effect. The variability of the change in individual nodule volume was statistically significant when comparisons were made across time (P = 0.0032). FNAB of thyroid nodules results in significant individual changes in volume after the procedure. Studies, such as the effect of TSH suppression on thyroid nodule volume, that incorporate the FNAB in both control and treatment arms of the experimental design, need to take these changes into account, less erroneous conclusions result.
促甲状腺激素（TSH）抑制疗法对甲状腺结节的有效性仍存在争议。先前的研究假定，在设立对照组和治疗组之前用于确认良性状况的细针穿刺活检（FNAB）对结节体积没有影响。17例未经治疗的甲状腺功能正常患者，其临床孤立性甲状腺结节在高分辨率超声下为实性，在细胞学检查中为胶样甲状腺肿，在FNAB之前、之后立即、1个月和6个月后进行了结节体积的超声测量。分析了每个时间段的大小差异和个体变异性。FNAB后任何时间点的甲状腺结节平均体积均无显著差异；然而，结节体积的变化在患者中非常显著且呈双向性，掩盖了累积效应。当跨时间进行比较时，单个结节体积变化的变异性具有统计学意义（P = 0.0032）。甲状腺结节的FNAB术后会导致个体体积发生显著变化。在实验设计的对照组和治疗组中都纳入FNAB的研究，如TSH抑制对甲状腺结节体积的影响等，需要考虑这些变化，否则会得出错误结论。
