Unit of Endocrinology, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 8, 00168 Rome, Italy.
J Endocrinol Invest. 2013 Apr;36(4):233-6. doi: 10.3275/8471. Epub 2012 Jun 25.
Patients with autonomously functioning thyroid nodules (AFTN) may not have an abnormal TSH value, particularly in iodine-deficient areas.
To verify the accuracy of TSH as screening test in detecting AFTN and to evaluate ultrasonographic features of thyroid nodules which have resulted autonomously functioning at thyroid scintigraphy (TS).
Seventy-eight patients with nodular goiter, no marker of autoimmunity and at least one AFTN at TS were selected and divided in: Group 1 (no.=25) with TSH>0.35 IU/l, and Group 2 (no.=53) with TSH≤0.35 IU/l.
In Group1 the mean nodule diameter was 19.8±9.4 mm; 12 nodules were isoechoic, 2 hyperechoic, and 11 hypoechoic. Vascular pattern was type I in 4, type II in 6 and type III in 15 nodules. In Group 2 the mean nodule diameter was 28.6±14.2 mm; 27 nodules were isoechoic, 9 hyperechoic and 17 hypoechoic. Vascular pattern was type I in 14, type II in 15 and type III in 24 nodules.
In our study TSH alone was not able to identify AFTN in 32% of the patients. All hot nodules predominantly showed an isoechoic pattern with peri-intranodular vascularization; however, the presence of this pattern was not statistically significant. Moreover, we noticed a weak inverse correlation between the diameter of AFTN and TSH level. In conclusion, TS is the most sensitive tool to detect AFTN, allowing a precocious diagnosis even in the presence of a normal TSH value.
自主功能性甲状腺结节（AFTN）患者的 TSH 值可能正常，尤其是在碘缺乏地区。
验证 TSH 作为 AFTN 筛查试验的准确性，并评估甲状腺闪烁显像（TS）显示自主功能的甲状腺结节的超声特征。
选择 78 例结节性甲状腺肿、无自身免疫标志物且至少有一个 AFTN 的患者进行研究，并将其分为两组：TSH>0.35 IU/L 的组 1（n=25）和 TSH≤0.35 IU/L 的组 2（n=53）。
在组 1 中，结节平均直径为 19.8±9.4mm；12 个结节为等回声，2 个为高回声，11 个为低回声。4 个结节的血管模式为 I 型，6 个为 II 型，15 个为 III 型。在组 2 中，结节平均直径为 28.6±14.2mm；27 个结节为等回声，9 个为高回声，17 个为低回声。14 个结节的血管模式为 I 型，15 个为 II 型，24 个为 III 型。
在我们的研究中，TSH 单独检查未能在 32%的患者中识别出 AFTN。所有热结节主要表现为等回声模式，伴结节内血管化；然而，这种模式的存在没有统计学意义。此外，我们注意到 AFTN 的直径与 TSH 水平之间存在微弱的负相关。总之，TS 是检测 AFTN 最敏感的工具，即使 TSH 值正常，也能实现早期诊断。
