Zelmanovitz T, Zelmanovitz F, Genro S, Gus P, de Azevedo M J, Gross J L
Serviço de Endocrinologia, Hospital de Clínicas de Porto Alegre.
Rev Assoc Med Bras (1992). 1995 Mar-Apr;41(2):86-90.
The factors associated with post-thyroidectomy goiter recurrence in benign thyroid disease are not clearly defined, especially prophylactic thyroxine treatment. PURPOSE--To determine the prevalence, characteristics and associated factors of recurrence of goiter post-thyroidectomy in patients submitted to surgery for benign disease. METHODS--Sixty-six patients, 53 female and 13 male (mean age = 51 yrs., range 20-82 yrs.), previously (5.6 +/- 6.1 yrs.) submitted to thyroidectomy (lobectomy, n = 50; nodulectomy, n = 5; subtotal thyroidectomy, n = 11) for benign thyroid disease were included. Measurements of T3, T4, TSH, thyroid microsomal autoantibody titers and thyroid ultrasonography were performed at the time of the study. Recurrence of goiter post-thyroidectomy was defined on ultrasonography as the presence of residual thyroid volume > 20mL and/or new nodules > 0.5mL not detected at surgery. RESULTS--Seven patients (10%) developed recurrence of goiter. The post-operative follow-up period was longer in the recurrence group and there was no difference between the two groups as to age, sex, familial history of thyropathy and preoperative goiter diagnosis. In multiple regression analysis only the following post-operative period was significantly associated to goiter recurrence (beta = 0.02; R2 = 0.16; p < 0.05) and influenced the goiter recurrence rate by 14%. Familial history of thyropathy, thyroxine treatment in non-supressible doses after thyroidectomy and seric T4 and TSH levels did not influence the recurrence. CONCLUSION--Recurrence of goiter post-thyroidectomy occurs in a small number of patients and is related to longer post-operative follow-up time. Thyroxine treatment in non-supressible doses after surgery is not related to goiter recurrence prevention.
良性甲状腺疾病患者甲状腺切除术后甲状腺肿复发的相关因素尚未明确界定，尤其是预防性甲状腺素治疗。目的——确定因良性疾病接受手术的患者甲状腺切除术后甲状腺肿复发的患病率、特征及相关因素。方法——纳入66例患者，其中女性53例，男性13例（平均年龄51岁，范围20 - 82岁），此前（5.6±6.1年）因良性甲状腺疾病接受过甲状腺切除术（叶切除术50例；结节切除术5例；次全甲状腺切除术11例）。在研究时进行T3、T4、TSH、甲状腺微粒体自身抗体滴度测量及甲状腺超声检查。甲状腺切除术后甲状腺肿复发在超声检查中定义为残余甲状腺体积>20mL和/或出现手术时未检测到的新结节>0.5mL。结果——7例患者（10%）出现甲状腺肿复发。复发组的术后随访期更长，两组在年龄、性别、甲状腺疾病家族史及术前甲状腺肿诊断方面无差异。多因素回归分析显示，仅术后时间与甲状腺肿复发显著相关（β = 0.02；R2 = 0.16；p < 0.05），且使甲状腺肿复发率增加14%。甲状腺疾病家族史、甲状腺切除术后不可抑制剂量的甲状腺素治疗以及血清T4和TSH水平均不影响复发。结论——甲状腺切除术后甲状腺肿复发发生在少数患者中，且与较长的术后随访时间有关。术后不可抑制剂量的甲状腺素治疗与预防甲状腺肿复发无关。
