Rudzki Grzegorz Mieczysław, Lenart-Lipińska Monika, Smoleń Agata, Chrapko Beata E, Matyjaszek-Matuszek Beata
Department of Endocrinology, Medical University of Lublin, Poland.
Department of Epidemiology and Clinical Research Methodology, Medical University of Lublin, Poland.
Endokrynol Pol. 2019;70(2):157-164. doi: 10.5603/EP.a2018.0088. Epub 2018 Nov 27.
Subclinical hyperthyroidism (SCH), also known as mildly symptomatic hyperthyroidism, has recently been diagnosed more frequently. One of the main endogenous causes of this disorder is autonomously functioning thyroid nodule (AFTN). Despite the fact that it is usually asymptomatic, SCH entails repercussions on the cardiovascular system and bone, and it carries a risk of progression to overt hyperthyroidism with a typical clinical picture. Treatment is still controversial, and its benefits are widely debated in literature.
From 459 patients authors selected a group of 49 patients (10.6% of all subjects with hyperthyroidism), 41 women (83.7%) with AFTN at the stage SCH treated in the Outpatient Endocrinological Clinic and the Department of Endocrinology of the Medical University of Lublin over a three-year period. The method applied in the study was a retrospective analysis of medical records with a particular account of medical history, physical examination, and additional tests obtained during the process of diagnostic and therapeutic procedures.
Forty-one patients (83.7%) suffered from typical symptoms of hyperthyroidism; only eight patients (16.3%) were asymptomatic. The most frequently reported symptoms were tachycardia in women (51.2%) and anxiety in men (50%). The type of thyrostatic drugs and the length of therapy did not affect the outcome of iodine-131 therapy. In the vast majority of the patients (87.8%) radioidodine therapy was effective; 30 patients (61.2%) reached euthyreosis and 13 patients (22.5%) developed hypothyroidism.
Most patients with SCH in the course of AFTN suffered from typical symptoms of overt hyperthyroidism; only every sixth patient was asymptomatic. The volume of autonomous adenomas did not affect the result of 131I therapy; however, the impact of AFTN volume as well as the thyroid volume on RIT efficacy requires futher investigation. In the vast majority of patients 131I therapy was an effective method of treatment, and an earlier therapeutic effect was observed more often in the patients with focal lesions located in the right lobe.
亚临床甲状腺功能亢进症（SCH），也被称为轻度症状性甲状腺功能亢进症，近年来诊断更为频繁。这种疾病的主要内源性病因之一是自主功能性甲状腺结节（AFTN）。尽管SCH通常无症状，但它会对心血管系统和骨骼产生影响，并且有进展为典型临床表现的显性甲状腺功能亢进症的风险。治疗仍存在争议，其益处也在文献中广泛讨论。
作者从459例患者中选取了一组49例患者（占所有甲状腺功能亢进症患者的10.6%），这些患者为年龄在SCH阶段的AFTN女性患者41例（83.7%），她们在三年期间于门诊内分泌诊所和卢布林医科大学内分泌科接受治疗。本研究采用的方法是对病历进行回顾性分析，特别关注病史、体格检查以及诊断和治疗过程中进行的其他检查。
41例患者（83.7%）出现典型的甲状腺功能亢进症状；仅8例患者（16.3%）无症状。最常报告的症状在女性中是心动过速（51.2%），在男性中是焦虑（50%）。抗甲状腺药物的类型和治疗时长并未影响碘-131治疗的结果。绝大多数患者（87.8%）放射性碘治疗有效；30例患者（61.2%）达到甲状腺功能正常，13例患者（22.5%）出现甲状腺功能减退。
在AFTN病程中的大多数SCH患者出现典型的显性甲状腺功能亢进症状；仅每六例患者中有一例无症状。自主性腺瘤的大小并未影响131I治疗的结果；然而，AFTN大小以及甲状腺大小对放射性碘治疗疗效的影响需要进一步研究。在绝大多数患者中，131I治疗是一种有效的治疗方法，并且在位于右叶的局灶性病变患者中更常观察到更早的治疗效果。
