Department of Medico-Surgical Sciences and Biotechnologies'Sapienza' University of Rome, Latina, Italy.
Endocrinology UnitAUSL Latina, Latina, Italy.
Eur J Endocrinol. 2016 Dec;175(6):615-622. doi: 10.1530/EJE-16-0568. Epub 2016 Sep 19.
Autonomously functioning thyroid areas may be associated with subclinical or overt hyperthyroidism, but may exist even in the presence of normal TSH. This study was aimed at comparing the rate of autonomously functioning areas and their cardiac sequelae in patients with nodular goitre studied with the usual and a novel approach.
In total 490 adult outpatients with thyroid nodular goitre, living in a mild iodine-deficient area, were selected in our referral centre for thyroid diseases from 2009 to 2014 on the basis of a suspicion of thyroid functional autonomy. They were divided in three groups according to a non-conventional approach (excessive response to thyroxine treatment: group 1) or conventional approach (low/normal TSH with clinical suspicion or low TSH: groups 2 and 3). All patients of the study with the suspicion of thyroid functional autonomy underwent thyroid scan with radioactive iodine (I) uptake (RAIU).
The percentage of confirmed thyroid functional autonomy was 319/490, being significantly higher in group 3 than in groups 1 and 2 (81.5 vs 64.7 vs 52.6%; chi-square P < 0.0001). However, the diagnosis with non-conventional approach was made at a significant earlier age (P < 0.0001). Cardiac arrhythmias as well as atrial fibrillation were similarly detected by conventional and non-conventional approaches (chi-square test: P = 0.2537; P = 0.8425).
The hyper-responsiveness to thyroxine treatment should induce the suspicion of thyroid functional autonomy at an early stage, allowing to detect autonomous functioning areas in apparently euthyroid patients.
自主功能甲状腺区域可能与亚临床或显性甲状腺功能亢进有关，但即使在 TSH 正常的情况下也可能存在。本研究旨在比较结节性甲状腺肿患者使用常规和新方法研究时自主功能区域及其心脏后遗症的发生率。
在 2009 年至 2014 年期间，我们在甲状腺疾病转诊中心根据甲状腺功能自主性的怀疑，从生活在轻度碘缺乏地区的 490 名成年甲状腺结节性甲状腺肿门诊患者中选择了 490 名患者。他们根据非传统方法（甲状腺素治疗过度反应：第 1 组）或常规方法（低/正常 TSH 伴临床怀疑或低 TSH：第 2 和 3 组）分为三组。所有怀疑甲状腺功能自主性的研究患者均接受放射性碘（I）摄取甲状腺扫描（RAIU）。
确诊甲状腺功能自主性的比例为 319/490，第 3 组明显高于第 1 组和第 2 组（81.5%比 64.7%比 52.6%；卡方检验 P<0.0001）。然而，非传统方法的诊断年龄明显更早（P<0.0001）。常规和非传统方法均可检测到心律失常和心房颤动（卡方检验：P=0.2537；P=0.8425）。
甲状腺素治疗的高反应性应在早期引起对甲状腺功能自主性的怀疑，从而允许在看似甲状腺功能正常的患者中检测到自主功能区域。
