Herrmann B L, Baumann H, Janssen O E, Görges R, Schmid K W, Mann K
Clinic of Endocrinology, Center of Internal Medicine, University of Essen, Germany.
Exp Clin Endocrinol Diabetes. 2004 May;112(5):225-30. doi: 10.1055/s-2004-817967.
In patients with acromegaly, the exact incidence of thyroid disorders is still controversial and less is known about the impact of disease activity and successful treatment. To address this issue, we investigated 73 acromegalic patients (age 55 +/- 13 yr; mean +/- SD) by ultrasonography in comparison to an age-matched control group (54 +/- 1 yr) in the same moderate iodine deficient area (retrospective study). These non-acromegalic volunteers (n = 199) were examined in the same clinic during a thyroid screening test. At the time of examination, 52 (71.2 %) of the acromegalic patients were active, 17 (23.3 %) were cured, and 4 (5.5 %) were controlled with somatostatin analogues. The prevalence of goiter (normal range < 18 ml female, < 25 ml male) was significantly higher (82.2 %) in the mixed group of acromegalics (active, well controlled, cured; n = 73) and in the active group (90.4 %) than in the control group (n = 199, 18.1 %, p < 0.001). Thyroid nodules were found in 63.0 % of the mixed group of acromegalics and in 71.2 % of patients with active disease (33.1 % in controls, p < 0.001). (99 m)Tc scintigraphy revealed thyroid autonomy in 9/73 (12.3 %) and cold nodules in 19/73 (26.0 %) patients. Thyroid cancer was diagnosed in 4 (5.5 %) of acromegalic patients (3 papillary and 1 follicular carcinoma). We found a weak correlation between the disease duration and the initial thyroid volume (r = 0.54, p < 0.0056). Thirty-seven newly diagnosed acromegalics were followed over a period of 7.3 +/- 4.1 years. 5 (13.5 %) of these patients remained active, 8 (21.6 %) were controlled with somatostatin analogues, and 24 (64.9 %) were cured. The mean age, sex distribution, disease duration, prevalence of TSH-deficiency, and initial thyroid volume (46 +/- 11 ml in active, 42 +/- 7 ml in controlled, and 45 +/- 5 ml in cured patients) did not differ statistically between the three groups. In patients with active acromegaly, thyroid volume increased by 19.5 +/- 8.1 %. In contrast, thyroid volume decreased in the group of medically controlled and cured acromegalics (- 21.5 +/- 7.1 %; p < 0.005 and - 24.2 +/- 5.7 %; p < 0.002, respectively). No correlation was found between thyroid volume and TSH levels, levothyroxine and/or iodide administration neither in TSH sufficient nor in TSH insufficient patients. In conclusion, successful treatment of patients with active acromegaly decreases thyroid volume. Cold nodules and thyroid cancer frequently occur in acromegalic patients.
在肢端肥大症患者中，甲状腺疾病的确切发病率仍存在争议，关于疾病活动度和成功治疗的影响了解较少。为解决这一问题，我们对73例肢端肥大症患者（年龄55±13岁；均值±标准差）进行了超声检查，并与同一中度碘缺乏地区年龄匹配的对照组（54±1岁）进行比较（回顾性研究）。这些非肢端肥大症志愿者（n = 199）在甲状腺筛查期间于同一诊所接受检查。在检查时，52例（71.2%）肢端肥大症患者处于疾病活动期，17例（23.3%）已治愈，4例（5.5%）通过生长抑素类似物得到控制。在肢端肥大症患者混合组（活动期、病情良好控制、已治愈；n = 73）和活动期组（90.4%）中，甲状腺肿（正常范围：女性＜18 ml，男性＜25 ml）的患病率显著高于对照组（n = 199，18.1%，p＜0.001）。在肢端肥大症患者混合组中，63.0%发现有甲状腺结节，在疾病活动期患者中为71.2%（对照组为33.1%，p＜0.001）。（99m）Tc闪烁扫描显示，73例患者中有9例（12.3%）存在甲状腺自主性，19例（26.0%）有冷结节。4例（5.5%）肢端肥大症患者被诊断为甲状腺癌（3例乳头状癌和1例滤泡状癌）。我们发现疾病持续时间与初始甲状腺体积之间存在弱相关性（r = 0.54，p＜0.0056）。对37例新诊断的肢端肥大症患者进行了7.3±4.1年的随访。这些患者中，5例（13.5%）仍处于活动期，8例（21.6%）通过生长抑素类似物得到控制，24例（64.9%）已治愈。三组之间的平均年龄、性别分布、疾病持续时间、促甲状腺激素缺乏症患病率以及初始甲状腺体积（活动期患者为46±11 ml，病情控制患者为42±7 ml，已治愈患者为45±5 ml）在统计学上无差异。在活动期肢端肥大症患者中，甲状腺体积增加了19.5±8.1%。相比之下，在药物控制和已治愈的肢端肥大症患者组中，甲状腺体积减小（分别为-21.5±7.1%；p＜0.005和-24.2±5.7%；p＜0.002）。在促甲状腺激素水平正常和促甲状腺激素水平不足的患者中，均未发现甲状腺体积与促甲状腺激素水平、左甲状腺素和/或碘剂给药之间存在相关性。总之，成功治疗活动期肢端肥大症患者可使甲状腺体积减小。冷结节和甲状腺癌在肢端肥大症患者中频繁出现。
