Giusti M, Caorsi V, Mortara L, Caputo M, Monti E, Schiavo M, Bagnara M C, Minuto F, Bagnasco M
Endocrine Unit, San Martino University Hospital, Genoa, Italy,
Endocrine. 2014 Mar;45(2):221-9. doi: 10.1007/s12020-013-9959-1. Epub 2013 Apr 26.
In multinodular goitre (MNG), low radioiodine (RAI) activity after recombinant human (rh) TSH is able to reduce thyroid volume (TV) and improve symptoms. Our aim was to evaluate the long-term outcome of RAI after rhTSH treatment in patients who were divided according to their baseline TSH levels. Eighteen patients (69.2 ± 6.1 year) presented non-toxic (TSH >0.3 mIU/l) MNG (TV: 61.0 ± 3.8 ml; group 1), while 13 patients (74.1 ± 7.9 year) had non-autoimmune pre-toxic (TSH <0.3 mIU/l) MNG (TV: 82.6 ± 14.4 ml; group 2). TSH, thyroid hormones, TV (by ultrasonography), body mass index (BMI), symptoms and quality of life (QoL) were evaluated. Treatment induced short-term thyrotoxicosis in both groups, but this was slightly more marked in group 2 than in group 1. The number and severity of adverse events were similar. The follow-up period was 55.3 ± 4.1 months in group 1 and 57.2 ± 5.1 months in group 2. The final TV reduction was similar in groups 1 (63.4 ± 3.6%) and 2 (57.2 ± 4.6%) and TV reduction positively correlated only with initial TV. At the last examination, 14 group-1 subjects were on L-T4 therapy, while 2 group-2 subjects were on methimazole. An increase in BMI was noted only in group 2. MNG-related symptoms were significantly reduced in both groups. Symptoms related to sub-clinical hyperthyroidism improved in group 2, while no significant changes in QoL were noted in either group. This study confirms the effectiveness of rhTSH adjuvant treatment in reducing TV after low RAI activities, irrespective of baseline thyroid status. TSH levels <0.3 mIU/l proved to be predictive of a more severe thyrotoxic phase after rhTSH and RAI, while initial TSH levels >0.3 mIU/l were more frequently followed by a need for L-T4 therapy. Compressive symptoms improved in the majority of subjects.
在多结节性甲状腺肿（MNG）中，重组人（rh）促甲状腺激素（TSH）刺激后低剂量放射性碘（RAI）能减小甲状腺体积（TV）并改善症状。我们的目的是评估根据基线TSH水平分组的患者在rhTSH治疗后RAI的长期疗效。18例患者（69.2±6.1岁）表现为非毒性（TSH>0.3 mIU/l）MNG（TV：61.0±3.8 ml；第1组），而13例患者（74.1±7.9岁）患有非自身免疫性毒性前期（TSH<0.3 mIU/l）MNG（TV：82.6±14.4 ml；第2组）。评估了TSH、甲状腺激素、TV（通过超声检查）、体重指数（BMI）、症状和生活质量（QoL）。治疗在两组中均引起短期甲状腺毒症，但第2组比第1组更明显。不良事件的数量和严重程度相似。第1组的随访期为55.3±4.1个月，第2组为57.2±5.1个月。两组最终的TV减小相似，第1组为（63.4±3.6%），第2组为（57.2±4.6%），且TV减小仅与初始TV呈正相关。在最后一次检查时，第1组的14名受试者接受左甲状腺素（L-T4）治疗，而第2组的2名受试者接受甲巯咪唑治疗。仅在第2组中观察到BMI增加。两组中与MNG相关的症状均显著减轻。第2组中与亚临床甲状腺功能亢进相关的症状有所改善，而两组的QoL均无显著变化。本研究证实了rhTSH辅助治疗在低剂量RAI后减小TV的有效性，与基线甲状腺状态无关。TSH水平<0.3 mIU/l被证明可预测rhTSH和RAI后更严重的甲状腺毒症期，而初始TSH水平>0.3 mIU/l的患者更常需要L-T4治疗。大多数受试者的压迫症状得到改善。
