Elte J W, Bussemaker J K, Haak A
Department of Endocrinology, University Hospital, Leiden, The Netherlands.
Postgrad Med J. 1990 Mar;66(773):186-90. doi: 10.1136/pgmj.66.773.186.
In this communication data on the natural history of euthyroid multinodular goitres are presented. From a total group of 140 patients (mean age 54.6 years, 14 men and 126 women; 88 with autonomous, 52 with non-autonomous function), follow-up data were available for 90 patients (mean age 54.0 years, 11 men and 79 women; 64 with autonomous, 26 with non-autonomous function). During follow-up (means: 5.0 years, maximum 12.2 years) transitions in function were seen 15 times; 8 autonomous patients became hyperthyroid after less than 1-7 years. There were 6 transitions from non-autonomy to autonomy and 1 from autonomy to non-autonomy. One patient who demonstrated the whole cycle from non-autonomy through autonomy up to hyperthyrodism is described in more detail. In one patient operated upon because of hyperparathyroidism a follicular carcinoma was found by chance. Mechanical problems were the reason for surgery in 6 patients only, 16 patients were operated upon because of cosmetic reasons (mostly in the early years of the study). Finally, results from 19 TRH tests in 16 autonomous patients suggest that TRH tests in patients with autonomously functioning euthyroid multinodular goitres are not yet redundant.
在本交流中，展示了关于甲状腺功能正常的多结节性甲状腺肿自然病史的数据。在总共140例患者（平均年龄54.6岁，14例男性和126例女性；88例有自主功能，52例无自主功能）中，有90例患者（平均年龄54.0岁，11例男性和79例女性；64例有自主功能，26例无自主功能）有随访数据。在随访期间（平均：5.0年，最长12.2年），功能转变出现了15次；8例有自主功能的患者在不到1 - 7年后变为甲状腺功能亢进。有6次从无自主功能转变为有自主功能，1次从有自主功能转变为无自主功能。详细描述了1例展示了从无自主功能经过有自主功能直至甲状腺功能亢进整个过程的患者。在1例因甲状旁腺功能亢进接受手术的患者中偶然发现了滤泡癌。仅6例患者因机械问题接受手术，16例患者因美容原因接受手术（大多在研究早期）。最后，16例有自主功能患者的19次促甲状腺激素释放激素（TRH）试验结果表明，对于有自主功能的甲状腺功能正常的多结节性甲状腺肿患者，TRH试验仍有必要。
