Sakane S
First Department of Internal Medicine, Osaka Medical College, Takatsuki, Japan.
Nihon Naibunpi Gakkai Zasshi. 1990 May 20;66(5):543-56. doi: 10.1507/endocrine1927.66.5_543.
Swelling of the thyroid gland is a common symptom in patients with Graves' disease. However, until recently there were no adequate means of measuring the thyroid volume. In this study, thyroid volume (in Graves' disease patients on antithyroid drug (ATD) therapy) was measured serially by a new ultrasound technique involving the use of a specifically programmed computer. The relationships between thyroid volume and prognosis, and between thyroid volume and serum thyroglobulin (Tg) concentration were examined. Sixty untreated patients with Graves' disease and 62 healthy subjects were included in the study. Twenty of the 60 patients with Graves' disease who had no anti-Tg antibodies underwent serial measurement of thyroid volume and serum Tg concentration during long term (18-42 months) ATD therapy. Thyroid volume in normal subjects ranged from 5.6 ml to 20.2 ml, with a mean of 12.0 +/- 4.0 ml. In patients with untreated Graves' disease, the volume ranged from 13.3 to 190.7 ml with a mean of 40.2 +/- 27.8 ml (n = 60). Thyroid volume was significantly correlated with both serum Tg concentration (n = 20, r = 0.678, p less than 0.01) and serum TSH receptor antibody activity (n = 18, r = 0.590, p less than 0.01). During ATD therapy, the thyroid volume decreased gradually in most patients. Eleven of 20 treated patients experienced remission after therapy was discontinued, and in these patients, thyroid volume was significantly smaller (p less than 0.01) than before treatment. Four patients developed hypothyroidism due to over dosage of ATD at which time thyroid volume increased in all four. In the course of therapy, even during episodes of hypothyroidism changes in serum Tg concentrations paralleled changes in thyroid volume. After 12 months of therapy, thyroid volume expressed as a percentage of the pretreatment value was significantly smaller in patients in remission (77.6 +/- 8.9%) than in those who did not show remission (92.4 +/- 11.6%). These data suggest that serial ultrasonographic measurement of thyroid volume is useful in predicting the course of hyperthyroidism in ATD-treated patients with Graves' disease.
甲状腺肿大是格雷夫斯病患者的常见症状。然而，直到最近，仍没有足够的方法来测量甲状腺体积。在本研究中，通过一种涉及使用专门编程计算机的新超声技术，对接受抗甲状腺药物（ATD）治疗的格雷夫斯病患者的甲状腺体积进行了连续测量。研究了甲状腺体积与预后之间以及甲状腺体积与血清甲状腺球蛋白（Tg）浓度之间的关系。60例未经治疗的格雷夫斯病患者和62名健康受试者纳入了研究。60例格雷夫斯病患者中，20例无抗Tg抗体，在长期（18 - 42个月）的ATD治疗期间，对其甲状腺体积和血清Tg浓度进行了连续测量。正常受试者的甲状腺体积范围为5.6毫升至20.2毫升，平均为12.0±4.0毫升。未经治疗的格雷夫斯病患者的甲状腺体积范围为13.3至190.7毫升，平均为40.2±27.8毫升（n = 60）。甲状腺体积与血清Tg浓度（n = 20，r = 0.678，p < 0.01）和血清促甲状腺激素受体抗体活性（n = 18，r = 0.590，p < 0.01）均显著相关。在ATD治疗期间，大多数患者的甲状腺体积逐渐减小。20例接受治疗的患者中有11例在停药后病情缓解，在这些患者中，甲状腺体积显著小于治疗前（p < 0.01）。4例患者因ATD过量导致甲状腺功能减退，此时这4例患者的甲状腺体积均增大。在治疗过程中，即使在甲状腺功能减退发作期间，血清Tg浓度的变化也与甲状腺体积的变化平行。治疗12个月后，病情缓解患者的甲状腺体积以治疗前值的百分比表示，显著小于未缓解患者（77.6±8.9% 对 92.4±11.6%）。这些数据表明，对接受ATD治疗的格雷夫斯病患者进行连续超声测量甲状腺体积，有助于预测甲亢的病程。
