Hubinois P, Mogenet M, Reynier J
Nouv Presse Med. 1982 Mar 13;11(12):923-6.
Heteromultinodular goitres are frequent and the involutive forms require early surgical treatment for three reasons: these goitres are usually resistant to medical treatment; association with carcinoma is not uncommon (6.5% in this series); and the late surgery is hazardous, as it leads to extensive tissue resection and often entails a risk of recurrence and lesions of the parathyroid glands. Post-operative hormonal treatment should be reserved to those patients who have had wide tissue resection (replacement therapy for life, monitored by TSH assays) or to young patients who require a 2-year protective treatment. Prevention may perhaps be achieved by systematic 2-3 years' treatment of active homogenous hyperplasia in young subjects. Hyperplasia has a natural tendency to nodular involution, in most cases over several decades, but curiously, 30-35 years' old adults with large multinodular goitres are being operated upon as though these lesions had greater evolutive potential. This could be an argument in favour of post-operative protective therapy in these young patients.
多结节性甲状腺肿很常见，其萎缩性类型需要早期手术治疗，原因有三：这些甲状腺肿通常对药物治疗耐药；与癌症相关并不罕见（本系列中为6.5%）；晚期手术风险大，因为会导致广泛的组织切除，且常常有复发风险和甲状旁腺损伤。术后激素治疗应仅用于那些进行了广泛组织切除的患者（终身替代治疗，通过促甲状腺激素检测监测）或需要两年保护性治疗的年轻患者。预防或许可以通过对年轻受试者的活动性均匀增生进行系统的2至3年治疗来实现。增生有自然发展为结节性萎缩的倾向，在大多数情况下会历经数十年，但奇怪的是，30至35岁患有大的多结节性甲状腺肿的成年人却接受了手术，仿佛这些病变具有更大的发展潜力。这可能是支持对这些年轻患者进行术后保护性治疗的一个理由。
