Radioiodine and percutaneous ethanol injection in the treatment of large toxic thyroid nodule: a long-term study.
Radioiodine and percutaneous ethanol injection in the treatment of large toxic thyroid nodule: a long-term study.
复制标题
放射性碘和经皮乙醇注射治疗大型毒性甲状腺结节：一项长期研究。
作者：
M. Zingrillo;M. Torlontano;M. Ghiggi;V. Frusciante;A. Varraso;A. Liuzzi;V. Trischitta
手术通常被推荐用于大的甲状腺毒性结节（TTN）。当手术不适用时，放射性碘（RAI）和经皮乙醇注射（PEI）都是替代治疗。在这项回顾性研究中，对43例TTN患者的非手术治疗的长期疗效进行了评价，这些患者是根据甲状腺功能亢进症的存在和相当大的结节（直径3和4 cm）在造影期间完全抑制对侧叶捕获而选择的。21例患者接受RAI治疗（给药剂量670+/-160 MBq;范围555-925），22例患者接受PEI治疗（6+/-1次;范围5-9）。在治疗前和治疗后定期评估FT 4、FT 3、促甲状腺激素（TSH）和结节体积。中位随访时间为36个月（范围：12-84）。与基线值相比，在3个月后和整个随访期间，两种疗法的血清FT 4、FT 3和结节体积均降低（p <0.01），血清TSH升高（p < 0.01）。在RAI和PEI处理组中，NOD 3体积减少百分比分别为66.8+/-22.0和78.4+/-18.0。在随访结束时，34例患者甲状腺功能正常（16例接受RAI治疗，18例接受PEI治疗）。4例RAI治疗患者（19%）显示TSH水平略高（4.2-5.3 mU/L），而3例PEI治疗患者（13.6%）尽管无临床症状，但TSH水平仍受到抑制。1例RAI治疗的患者（4.8%）在随访期间出现明显的甲状腺功能减退，然后接受L-甲状腺素治疗。1例患者（4.6%），最初通过PEI治愈，在随访期间新发甲状腺功能亢进。两种治疗均耐受良好。总之，这两种非手术治疗是有效的，也可以选择相对较大的TTN。具体而言，RAI似乎对治疗甲状腺功能亢进症更有效，但亚临床或临床甲状腺功能减退症的后遗症最小，而PEI治疗后，应考虑稳定的亚临床甲状腺功能亢进症或甲状腺功能亢进症复发的可能性。
Surgery is generally recommended for large thyroid toxic nodules (TTNs). When surgery is not applicable, both radioactive iodine (RAI) and percutaneous ethanol injection (PEI) are alternative treatments. In this retrospective study, the long-term efficacy of nonsurgical treatments was evaluated in 43 patients with TTN, selected on the basis of presence of hyperthyroidism and a fairly large nodule (3- and 4-cm in diameter) completely inhibiting controlateral lobe captation during scintigraphy. Twenty-one patients were treated by RAI (administered dose 670+/-160 MBq; range 555-925) and twenty-two were treated by PEI (6+/-1 sessions; range 5-9). FT4, FT3, thyrotropin (TSH), and nodule volume were assessed before and at fixed intervals after treatment. Median follow-up was 36 months (range, 12-84). Compared to baseline values, with both therapies, serum FT4, FT3, and nodule volume were decreased (p < 0.01) and serum TSH was increased (p < 0.01), after 3 months and during the entire follow-up. Nodule volume reduction percentage was 66.8+/-22.0 and 78.4+/-18.0, in the RAI- and PEI-treated groups, respectively. At the end of follow-up, 34 patients were euthyroid (16 RAI- and 18 PEI-treated). Four RAI-treated patients (19%) showed slightly high TSH levels (4.2-5.3 mU/L), whereas three PEI-treated patients (13.6%) still had suppressed TSH levels, although being clinically asymptomatic. One RAI-treated patient (4.8%) showed overt hypothyroidism during the follow-up period and was then treated with L-thyroxin. One patient (4.6%), who was initially cured by PEI, became newly hyperthyroid during the follow-up period. Both treatments were well-tolerated. In conclusion, both of these nonsurgical treatments are effective and may be chosen also for relatively large TTNs. Specifically, RAI seems to be more effective for treating hyperthyroidism but has minimal sequelae of subclinical or clinical hypothyroidism, while, after PEI treatment the possibility of stable subclinical hyperthyroidism or hyperthyroidism relapse should be taken into account.
DOI：
10.1056/nejm199302253280807
发表时间：
1993-02
期刊：
The New England journal of medicine
影响因子：
--
作者：
E. Mazzaferri
通讯作者：
E. Mazzaferri
影响因子：
158.5
作者：
SAWIN, CT;GELLER, A;DAGOSTINO, RB
通讯作者：
DAGOSTINO, RB