Muller R, Siggelkow H, Emrich D, Hufner M
Department of Gastroenterology and Endocrinology, Georg-August-Universitat, Gottingen, Germany.
Eur J Endocrinol. 1996 Mar;134(3):337-41. doi: 10.1530/eje.0.1340337.
In a prospective, randomized study we examined the influence of prophylactic short-term thyrostatic therapy on thyroid iodine metabolism in patients with euthyroid autonomy undergoing elective coronary angiography. From a total of 1177 patients, 51 fulfilled the criteria of euthyroid autonomy before coronary angiography (negative thyrotropin-releasing hormone test, 10-min uptake of at least 1.2%, 99mTc and no elevation of free thyroxine and free triiodothyronine indices) and were randomized into three groups: group 1 (N = 17) received 20mg/day of thiamazole and group 2 (N = 17) received 900 mg/day of sodium perchlorate; thyrostatic therapy was begun on the day before angiography and continued for 14 days; group 3 (N = 17) served as controls without treatment. Parameters of thyroid function-free thyroxine (FT4) index and free triiodothyronine (FT3) index, thyrotropin (TSH) and delta-TSH urine iodine excretion and 99mTc uptake were determined before and 30 days after coronary angiography. At the end of the study the mean FT4 index and FT3 index were elevated significantly in the control group compared with baseline values, but were still within the normal range. In contrast, the mean FT4 index and FT3 index remained unchanged in the treated groups. Four mild cases of hyperthyroidism were observed at the end of the study: two cases in the control group and one case in each of the treated groups. Thyrotropin suppression, urine iodine excretion and 99mTc uptake differed significantly between the treated groups and the control group. In the treated groups TSH suppression, urine iodine excretion and 99mTC uptake remained unchanged 30 days after coronary angiography compared with baseline values. In the control group the degree of TSH suppression and the level of urine iodine excretion increased (about twofold) significantly after coronary angiography, whereas 99mTc uptake decreased significantly (ca. 50%). In conclusion, short-term prophylactic thyrostatic therapy seems to have a protective effect against iodine excess in patients with euthyroid autonomy. However, mild hyperthyroidism could not be prevented in some cases. Probably a combination therapy of thiamazole and perchlorate would be more effective.
在一项前瞻性随机研究中，我们考察了预防性短期甲状腺抑制治疗对接受择期冠状动脉造影的甲状腺功能正常自主性患者甲状腺碘代谢的影响。在总共1177例患者中，51例在冠状动脉造影前符合甲状腺功能正常自主性标准（促甲状腺激素释放激素试验阴性，10分钟摄取率至少为1.2%，99mTc摄取率且游离甲状腺素和游离三碘甲状腺原氨酸指数无升高），并被随机分为三组：第1组（N = 17）接受20mg/天的甲巯咪唑，第2组（N = 17）接受900mg/天的高氯酸钠；甲状腺抑制治疗在造影前一天开始，持续14天；第3组（N = 17）作为未治疗的对照组。在冠状动脉造影前和造影后30天测定甲状腺功能参数——游离甲状腺素（FT4）指数、游离三碘甲状腺原氨酸（FT3）指数、促甲状腺激素（TSH）、Δ-TSH、尿碘排泄和99mTc摄取率。研究结束时，对照组的平均FT4指数和FT3指数与基线值相比显著升高，但仍在正常范围内。相比之下，治疗组的平均FT4指数和FT3指数保持不变。研究结束时观察到4例轻度甲状腺功能亢进病例：对照组2例，治疗组各1例。治疗组和对照组之间促甲状腺激素抑制、尿碘排泄和99mTc摄取率有显著差异。在治疗组中，冠状动脉造影后30天与基线值相比，TSH抑制、尿碘排泄和99mTC摄取率保持不变。在对照组中，冠状动脉造影后促甲状腺激素抑制程度和尿碘排泄水平显著增加（约两倍），而99mTc摄取率显著降低（约50%）。总之，短期预防性甲状腺抑制治疗似乎对甲状腺功能正常自主性患者的碘过量有保护作用。然而，在某些情况下无法预防轻度甲状腺功能亢进。可能甲巯咪唑和高氯酸盐联合治疗会更有效。
