Saller B, Hoermann R, Ritter M M, Morell R, Kreisig T, Mann K
Medizinische Klinik II, Ludwig-Maximilians-Universität, Munich, Germany.
Acta Endocrinol (Copenh). 1991 Dec;125(6):662-7. doi: 10.1530/acta.0.1250662.
In the treatment of endemic goitre, the concept of giving levothyroxine in combination with iodine offers a promising therapeutic approach by influencing not only TSH secretion but also intrathyroidal iodine content. However, little is known about the doses of iodine necessary to correct intrathyroidal iodine deficiency. To get more information on this important issue, we conducted a prospective, double-blind study on the effect of a monotherapy with 500 micrograms iodide/day and a combined treatment with 100 micrograms levothyroxine and 100 micrograms iodide/day on thyroid iodine concentration as measured by fluorescence scintigraphy. In a group of 12 patients, a 4-month treatment with 100 micrograms levothyroxine and 100 micrograms iodide/day did not significantly affect thyroid iodine concentration (0.35 +/- 0.14 vs 0.37 +/- 0.11 mg/g). The application of 500 micrograms iodide/day in these patients during a second 4-month period resulted in a sharp increase in thyroid iodine concentration from 0.37 +/- 0.11 to 0.61 +/- 0.14 mg/g (p less than 0.01). Another group of 8 patients first treated with 500 micrograms iodide/day also showed a significant increase in iodine concentration from 0.35 +/- 0.14 to 0.65 +/- 0.20 mg/g (p less than 0.01). After switching to the combination regimen during a second 4-month period, thyroid iodine concentration slightly decreased, particularly in those patients with high iodine concentrations after monotherapy with iodide (0.65 +/- 0.20 vs 0.50 +/- 0.12 mg/g, p less than 0.05). In conclusion, treatment with 500 micrograms iodide/day could sharply increase thyroid iodine concentration in patients with endemic goitre. In contrast, a combination of 100 micrograms levothyroxine and 100 micrograms iodide/day had no significant effect on thyroid iodine concentration.
在地方性甲状腺肿的治疗中，联合使用左甲状腺素和碘的理念提供了一种有前景的治疗方法，这不仅会影响促甲状腺激素（TSH）的分泌，还会影响甲状腺内碘含量。然而，对于纠正甲状腺内碘缺乏所需的碘剂量，人们知之甚少。为了获取有关这一重要问题的更多信息，我们进行了一项前瞻性双盲研究，以探究每日500微克碘化物单一疗法以及每日100微克左甲状腺素与100微克碘化物联合疗法对通过荧光闪烁扫描测量的甲状腺碘浓度的影响。在一组12名患者中，每日100微克左甲状腺素与100微克碘化物联合治疗4个月对甲状腺碘浓度没有显著影响（分别为0.35±0.14与0.37±0.11毫克/克）。在第二个4个月期间，这些患者每日应用500微克碘化物，导致甲状腺碘浓度从0.37±0.11急剧增加至0.61±0.14毫克/克（p<0.01）。另一组8名患者首先接受每日500微克碘化物治疗，碘浓度也从0.35±0.14显著增加至0.65±0.20毫克/克（p<0.01）。在第二个4个月期间改用联合治疗方案后，甲状腺碘浓度略有下降，尤其是在单一使用碘化物治疗后碘浓度较高的患者中（分别为0.65±0.20与0.50±0.12毫克/克，p<0.05）。总之，每日500微克碘化物治疗可使地方性甲状腺肿患者的甲状腺碘浓度急剧增加。相比之下，每日100微克左甲状腺素与100微克碘化物联合使用对甲状腺碘浓度没有显著影响。
