Negro R, Dazzi D, Pezzarossa A
Cattedra di Endocrinologia, Dipartimento di Medicina Interna e Scienze Biomediche, Università degli Studi di Parma, Via Gramsci, 14-43100 Parma.
Minerva Endocrinol. 2000 Mar;25(1):11-7.
Hypothyroidism and nodular goiter are two frequent endocrine diseases which respectively require substitutive and suppressive treatment with L-Thyroxine. Objective of this work was to evaluate the correspondence between expected and obtained TSH values in patients affected with hypothyroidism and nodular goiter submitted to L-Thyroxine treatment.
a questionnaire addressed to patients on L-Thyroxine has been available in consulting rooms of 12 family doctors of Lecce County (Italy) for a 6 month period. A hundred-twelve patients answered the questionnaire: 44 were on suppressive treatment for uni/multinodular goiter (group 1) and 68 were on substitutive treatment for hypothyroidism (group 2).
TSH dosage had been performed since less than 1 year in 91% of group 1 patients and in 87% of group 2 patients (p = ns), in group 1, 25% of TSH values were < 0.3 microU/ml, 68.2% between 0.3 and 4.5 microU/ml, 6.8% > 4.5 microU/ml (p < 0.001); in group 2, 25% of TSH values was < 0.3 microU/ml, 63.3% between 0.3 and 4.5 microU/ml, 11.8% > 4.5 microU/ml: (p < 0.001). The distribution of TSH values between the two groups was not significantly different. In patients on suppressive treatment TSH was suppressed in a number of patients significantly less in respect to the ones with not suppressed TSH value: 11 vs 33; p < 0.01; in patients on substitutive treatment the number of those ones with TSH values in between the normal range was not different from patients with TSH values above or below the normal range: 43 vs 25; p = ns. Considering the two groups together, in 52% of patients TSH was not correspondent to therapeutical objectives.
Inspite of regular checks of thyroid function, proper TSH values were achieved only in half of patients.
甲状腺功能减退症和结节性甲状腺肿是两种常见的内分泌疾病，分别需要用左旋甲状腺素进行替代治疗和抑制治疗。本研究的目的是评估接受左旋甲状腺素治疗的甲状腺功能减退症和结节性甲状腺肿患者的促甲状腺激素（TSH）预期值与实际值之间的符合情况。
在意大利莱切县12位家庭医生的诊室中，针对接受左旋甲状腺素治疗的患者发放了一份问卷，为期6个月。112名患者回答了问卷：44名接受单发性/多发性结节性甲状腺肿抑制治疗（第1组），68名接受甲状腺功能减退症替代治疗（第2组）。
第1组91%的患者和第2组87%的患者进行TSH检测的时间不到1年（p = 无显著差异）。在第1组中，25%的TSH值<0.3微国际单位/毫升，68.2%介于0.3和4.5微国际单位/毫升之间，6.8%>4.5微国际单位/毫升（p < 0.001）；在第2组中，25%的TSH值<0.3微国际单位/毫升，63.3%介于0.3和4.5微国际单位/毫升之间，11.8%>4.5微国际单位/毫升：（p < 0.001）。两组之间TSH值的分布无显著差异。在接受抑制治疗的患者中，TSH被抑制的患者数量明显少于TSH值未被抑制的患者：11例对33例；p < 0.01；在接受替代治疗的患者中，TSH值在正常范围内的患者数量与TSH值高于或低于正常范围的患者数量无差异：43例对25例；p = 无显著差异。将两组患者综合考虑，52%的患者TSH值未达到治疗目标。
尽管定期检查甲状腺功能，但只有一半的患者达到了合适的TSH值。
