La Rosa G L, Lupo L, Giuffrida D, Gullo D, Vigneri R, Belfiore A
University of Catania, Italy.
Ann Intern Med. 1995 Jan 1;122(1):1-8. doi: 10.7326/0003-4819-122-1-199501010-00001.
To determine the effectiveness of levothyroxine and potassium iodide in treating patients with benign solitary cold thyroid nodules.
Randomized controlled study.
Outpatient clinic at a university hospital.
80 patients with solitary solid cold thyroid nodules found to be benign at cytologic examination were randomly assigned to no treatment, suppressive levothyroxine (thyroid-stimulating hormone level, < 0.3 mU/L), or low-dose potassium iodide (2 mg every 2 weeks). Seventy patients completed the 1-year study. After 1 year, patients receiving treatment discontinued drug therapy and were re-evaluated 4 months later; patients receiving no treatment were given levothyroxine and were followed for a second year.
Nodule volume was measured by ultrasonography at 4-month intervals by an observer masked to treatment assignment.
Mean nodule volume decreased by 40% of the basal volume in the 23 patients receiving levothyroxine (P < 0.001) and by 23% of the basal volume in the 25 patients receiving potassium iodide (P = 0.053). Volume slightly increased in the 22 untreated patients (P = 0.085). A clinically relevant reduction in nodule volume (> or = 50%) was observed in 9 of 23 patients treated with levothyroxine, in 5 of 25 patients treated with potassium iodide, and in none of 22 untreated patients (P = 0.004). Only nodules with a volume of 10 mL or less were reduced; nodules with volumes of 5 mL or less shrank most frequently. Nodule volume did not relevantly increase in treated patients but did increase in 3 of the 22 untreated patients. Drug withdrawal resulted in an increased mean nodule volume (P = 0.004) after 4 months.
Levothyroxine and, to a lesser extent, potassium iodide are effective in arresting the growth or in reducing the volume of benign solitary solid cold thyroid nodules, especially small ones; discontinuation of therapy may result in resumed nodule growth.
确定左甲状腺素和碘化钾治疗良性孤立性冷甲状腺结节患者的有效性。
随机对照研究。
大学医院门诊。
80例经细胞学检查发现为良性的孤立实性冷甲状腺结节患者，随机分为不治疗组、抑制性左甲状腺素治疗组（促甲状腺激素水平<0.3 mU/L）或低剂量碘化钾治疗组（每2周2 mg）。70例患者完成了1年的研究。1年后，接受治疗的患者停止药物治疗，并在4个月后重新评估；未接受治疗的患者给予左甲状腺素，并随访第二年。
由对治疗分配不知情的观察者每隔4个月通过超声测量结节体积。
接受左甲状腺素治疗的23例患者的平均结节体积较基础体积减少了40%（P<0.001），接受碘化钾治疗的25例患者的平均结节体积较基础体积减少了23%（P = 0.053）。22例未治疗患者的结节体积略有增加（P = 0.085）。接受左甲状腺素治疗的23例患者中有9例、接受碘化钾治疗的25例患者中有5例观察到结节体积有临床意义的缩小（≥50%），而22例未治疗患者中无一例出现这种情况（P = 0.004）。仅体积为10 mL或更小的结节缩小；体积为5 mL或更小的结节最常缩小。治疗患者的结节体积没有明显增加，但22例未治疗患者中有3例结节体积增加。停药4个月后平均结节体积增加（P = 0.004）。
左甲状腺素以及在较小程度上碘化钾可有效阻止良性孤立实性冷甲状腺结节的生长或减小其体积，尤其是小的结节；停止治疗可能导致结节重新生长。
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