Luster M, Verburg F A, Scheidhauer K
Department of Nuclear Medicine, University of Ulm, Ulm, Germany.
Minerva Endocrinol. 2010 Sep;35(3):153-9.
Ultrasound, scintigraphy and sonographically guided fine-needle biopsy are the cornerstones in the diagnostic work-up multinodular goitre. Subsequent decisions for adequate treatments should be based on accurate tests to avoid unnecessary intervention. Especially in areas with endemic goitre a preselection of patients for the most effective procedure e.g. surgical or medical treatment is mandatory. Autoimmune hyperthyroidism (Graves' disease), solitary hyperfunctioning thyroid nodules and toxic multinodular goitre (Plummer's disease) constitute a clear indication for radioiodine treatment in many cases. Recently, there is an emerging role for I-131 in the treatment for so called subclinical hyperthyroidism caused by either of three first entities and for patients with non-toxic goitre, in whom surgery is not an option. These patients with large non toxic goitre encompass a group of patients who are euthyroid but may benefit from diminishment of thyroid volume. We review the spectrum of diagnostic tests and provide some recommendations regarding (nuclear medicine) therapy.
超声、闪烁扫描以及超声引导下细针穿刺活检是多结节性甲状腺肿诊断检查的基石。后续关于适当治疗的决策应基于准确的检查，以避免不必要的干预。尤其是在地方性甲状腺肿流行地区，必须对患者进行预先筛选，以便采用最有效的治疗方法，如手术或药物治疗。自身免疫性甲状腺功能亢进症（格雷夫斯病）、孤立性高功能性甲状腺结节和毒性多结节性甲状腺肿（普拉默病）在许多情况下构成放射性碘治疗的明确指征。最近，I - 131在治疗由前三种疾病中的任何一种引起的所谓亚临床甲状腺功能亢进症以及手术不可行的非毒性甲状腺肿患者方面正发挥着越来越重要的作用。这些患有巨大非毒性甲状腺肿的患者甲状腺功能正常，但可能会从甲状腺体积缩小中获益。我们回顾了诊断检查的范围，并就（核医学）治疗提供了一些建议。
