希腊无毒结节性甲状腺肿（NTNG）在抑制治疗下以及碘缺乏改善后的历程。

The odyssey of nontoxic nodular goiter (NTNG) in Greece under suppression therapy, and after improvement of iodine deficiency.

作者信息

Michalaki Marina, Kyriazopoulou Venetsana, Paraskevopoulou Panagiota, Vagenakis Apostolos G, Markou Kostas B

机构信息

Division of Endocrinology, Department of Internal Medicine, University of Patras Medical School, Patras, Greece.

出版信息

Thyroid. 2008 Jun;18(6):641-5. doi: 10.1089/thy.2007.0348.

DOI:10.1089/thy.2007.0348

PMID:18578614

Abstract

BACKGROUND

Nontoxic nodular goiter (NTNG) is common in endemic goiter regions. Thyroxine (T4) is often used to treat NTNG. There is little information regarding T4 treatment in regions that have recently become iodine sufficient. We studied the effect of T4 treatment on thyroid function tests in southwestern Greece (SWG), a recently iodine-sufficient area.

METHODS

We studied 827 residents of SWG (group A) to determine goiter prevalence, thyroid function, and urinary iodine concentration (UIC). Group B: 385 consecutive patients with thyroid dysfunction. Of these, 89 had NTNG and followed for 10 years on T4 treatment, and 296 had hyperthyroidism. Group C: 29 patients with NTNG, treated with triiodothyronine (T3) 50 mug/day and followed for 6 months. Measurements included serum T4 and 24-hour radioactive iodine uptake (RAIU) before and at the end of T3 administration.

RESULTS

The median UIC in group A was 114 microg/L. In group B (89 patients), the incidence of newly diagnosed hyperthyroidism was 5-7% per year with a cumulative percentage of 33% at the 10th year. The initial thyrotropin (TSH) was lower (0.78 +/- 0.51 mIU/L) in those who developed thyrotoxicosis compared to those who remained euthyroid (1.17 +/- 0.74 mIU/L) (p < 0.05). In 296 thyrotoxic patients, the incidence of autoimmune hyperthyroidism and toxic multi-nodular goiter (TMNG) was similar. In group C, 10/29 patients remained euthyroid and the 24-hour RAIU decreased by 49% during T3 treatment. Similarly, serum T4 decreased by 49%. In the remaining patients who developed hyperthyroidism, 24-hour RAIU and T4 were decreased by 19% and 22%, respectively.

CONCLUSIONS

In SWG, a recently iodine-sufficient region, the risk of developing hyperthyroidism in patients with NTNG after administration of 100-150 microg T4 is relatively high in those whose serum TSH before T4 treatment is in the lower normal range. Therefore, T4 treatment should be avoided in these patients.

摘要

背景

非毒性结节性甲状腺肿（NTNG）在地方性甲状腺肿地区很常见。甲状腺素（T4）常用于治疗NTNG。在最近碘充足的地区，关于T4治疗的信息很少。我们研究了T4治疗对希腊西南部（SWG）这一最近碘充足地区甲状腺功能检查的影响。

方法

我们研究了SWG的827名居民（A组），以确定甲状腺肿患病率、甲状腺功能和尿碘浓度（UIC）。B组：385例连续的甲状腺功能障碍患者。其中，89例患有NTNG并接受T4治疗10年，296例患有甲状腺功能亢进症。C组：29例患有NTNG的患者，每天服用50微克三碘甲状腺原氨酸（T3）并随访6个月。测量指标包括T3给药前和给药结束时的血清T4和24小时放射性碘摄取率（RAIU）。

结果

A组的UIC中位数为114微克/升。在B组（89例患者）中，新诊断的甲状腺功能亢进症发病率为每年5 - 7%，第10年的累积发病率为33%。发生甲状腺毒症的患者初始促甲状腺激素（TSH）较低（0.78±0.51 mIU/L），而甲状腺功能正常的患者为（1.17±0.74 mIU/L）（p<0.05）。在296例甲状腺毒症患者中，自身免疫性甲状腺功能亢进症和毒性多结节性甲状腺肿（TMNG）的发病率相似。在C组中，29例患者中有10例甲状腺功能保持正常，T3治疗期间24小时RAIU下降了49%。同样，血清T4下降了49%。在其余发生甲状腺功能亢进症的患者中，24小时RAIU和T4分别下降了19%和22%。