Papini E, Petrucci L, Guglielmi R, Panunzi C, Rinaldi R, Bacci V, Crescenzi A, Nardi F, Fabbrini R, Pacella C M
Department of Endocrine, Metabolic, and Digestive Diseases, Ospedale Regina Apostolorum, Albano, Rome, Italy.
J Clin Endocrinol Metab. 1998 Mar;83(3):780-3. doi: 10.1210/jcem.83.3.4615.
We studied for 5 yr a homogeneous group of 83 patients randomly assigned to a levothyroxine (L-T4) suppressive therapy or to a control group to evaluate changes in nodule or thyroid size, appearance of new nodules, and correlations with clinical parameters. In the control group, mean nodule volume increased significantly after 5 yr (2.12 +/- 1.46 vs. 1.46 +/- 0.77 mL), whereas in the treatment group it decreased, although not significantly (1.45 +/- 1.17 mL vs. 1.53 +/- 0.61 mL). Baseline nodule volume was not different in the two groups, but a significant difference was observed at 5 yr. After 5 yr, sonograms detected 12 new nodules in the control group (28.5%) and 3 (7.5%) in the treatment group. Nodule shrinkage was more frequent in patients with complete TSH suppression, but no correlation was found with other parameters. A significant increase in thyroid size was observed in the control group. In conclusion, long term TSH suppression induced volume reduction in only a subgroup of thyroid nodules, but effectively prevented the appearance of new lesions and increases in nodule and thyroid volume. As the changes in the natural history of nodular goiter are related to prolonged TSH suppression, which can induce unfavorable side-effects, L-T4 suppressive therapy should be reserved for small nodules in younger patients.
我们对83例患者进行了为期5年的研究，这些患者被随机分为左甲状腺素（L-T4）抑制治疗组或对照组，以评估结节或甲状腺大小的变化、新结节的出现情况以及与临床参数的相关性。在对照组中，5年后平均结节体积显著增加（2.12±1.46 vs. 1.46±0.77 mL），而治疗组中结节体积虽有下降但不显著（1.45±1.17 mL vs. 1.53±0.61 mL）。两组的基线结节体积无差异，但在5年时观察到显著差异。5年后，超声检查在对照组中发现12个新结节（28.5%），在治疗组中发现3个新结节（7.5%）。在促甲状腺激素（TSH）完全被抑制的患者中，结节缩小更为常见，但未发现与其他参数相关。对照组甲状腺大小显著增加。总之，长期TSH抑制仅在部分甲状腺结节亚组中导致体积减小，但能有效预防新病变的出现以及结节和甲状腺体积的增加。由于结节性甲状腺肿自然病程的变化与长期TSH抑制有关，而这可能会引发不良副作用，因此L-T4抑制治疗应仅用于年轻患者的小结节。
