Hegedüs Laszlo, Bonnema Steen J, Bennedbaek Finn N
Department of Endocrinology and Metabolism, Odense University Hospital, DK-5000 Odense C, Denmark.
Endocr Rev. 2003 Feb;24(1):102-32. doi: 10.1210/er.2002-0016.
The simple nodular goiter, the etiology of which is multifactorial, encompasses the spectrum from the incidental asymptomatic small solitary nodule to the large intrathoracic goiter, causing pressure symptoms as well as cosmetic complaints. Its management is still the cause of considerable controversy. The mainstay in the diagnostic evaluation is related to functional and morphological characterization with serum TSH and (some kind of) imaging. Because malignancy is just as common in patients with a multinodular goiter as patients with a solitary nodule, we support the increasing use of fine-needle aspiration biopsy (cytology). Most patients need no treatment after malignancy is ruled out. In case of cosmetic or pressure symptoms, the choice in multinodular goiter stands between surgery, which is still the first choice, and radioiodine if uptake is adequate. In addition to surgery, the solitary nodule, whether hot or cold, can be treated with percutaneous ethanol injection therapy. If hot, radioiodine is the therapy of choice. Randomized studies are scarce, and the side effects of nonsurgical therapy are coming into focus. Therefore, the use of the optimum option in the individual patient cannot at present be based on evidence. However, we are of the view that levothyroxine, although widely used, should no longer be recommended routinely for this condition. Within a few years, the introduction of recombinant human TSH and laser therapy may profoundly alter the nonsurgical treatment of simple nodular goiter.
单纯性结节性甲状腺肿的病因是多因素的,其范围涵盖从偶然发现的无症状小孤立结节到引起压迫症状及美容问题的巨大胸内甲状腺肿。其治疗仍然是相当有争议的问题。诊断评估的主要依据是通过血清促甲状腺激素(TSH)和(某种)影像学检查进行功能和形态学特征分析。因为多结节性甲状腺肿患者发生恶性病变的几率与孤立结节患者相同,所以我们支持增加细针穿刺活检(细胞学检查)的应用。大多数患者在排除恶性病变后无需治疗。对于多结节性甲状腺肿,若出现美容或压迫症状,治疗选择在手术(仍是首选)和放射性碘治疗(若摄取充足)之间。除手术外,孤立结节无论为“热结节”还是“冷结节”,都可用经皮乙醇注射疗法治疗。若为“热结节”,放射性碘是首选治疗方法。随机对照研究较少,非手术治疗的副作用正受到关注。因此,目前无法依据证据为个体患者选择最佳治疗方案。然而,我们认为,左甲状腺素尽管广泛应用,但不应再常规推荐用于此种情况。在未来几年内,重组人促甲状腺激素和激光治疗的引入可能会深刻改变单纯性结节性甲状腺肿的非手术治疗方法。