Levothyroxine treatment reduces thyroid size in children and adolescents with chronic autoimmune thyroiditis
Levothyroxine treatment reduces thyroid size in children and adolescents with chronic autoimmune thyroiditis
复制标题
DOI：
10.1210/jc.2005-2400
复制
发表时间：
2006-05-01
影响因子：
5.8
通讯作者：
Ivarsson, SA
中科院分区：
文献类型：
--
作者：
Svensson, J;Ericsson, UB;Ivarsson, SA
内容：对于慢性自身免疫性甲状腺炎（AIT）引起的甲状腺肿大儿童患者，使用左旋甲状腺素缩小甲状腺大小仍存在争议。在明显甲状腺功能减退的患者中，甲状腺体积减少的报道，而在亚临床甲状腺功能减退和甲状腺功能正常的患者中，其影响尚不清楚。目的：本研究的目的是评估左旋甲状腺素治疗对甲状腺大小的影响（通过甲状腺超声检查确定）。设计和设置：这项研究包括1987年至2004年期间在大学医院门诊治疗的AIT患者。90名AIT儿童（73名女孩和17名男孩，年龄6.1 - 17.7岁）被纳入研究。干预：干预是用左旋甲状腺素治疗，平均2.8年（范围0.5 - 10.2）。主要结果测量：在研究期间测量甲状腺体积SD评分（SDS）的变化。甲状腺功能正常的患者中位甲状腺体积SDS降低AIT诊断时，亚临床甲状腺功能减退（-1.4SDS，P <0.001）和明显甲状腺功能减退（-1.8SDS，P <0.002）。基线时甲状腺肿大（甲状腺体积> 2.0 SDS）的甲状腺功能减退和甲状腺功能正常患者的中位甲状腺体积SDS均降低（分别为-1.6和-0.9，P <0.001）。无甲状腺肿的甲状腺功能减退患者也降低了中位数甲状腺体积SDS（-1.2，P <0.004），而无甲状腺肿的甲状腺功能正常儿童则无变化。结论：左旋甲状腺素治疗可有效减少儿童患者的甲状腺体积，并建议用于治疗AIT引起的甲状腺肿，尤其是甲状腺功能减退的情况下，但也适用于甲状腺功能正常的儿童。
Context: The use of levothyroxine to reduce thyroid size in pediatric patients with goiter due to chronic autoimmune thyroiditis (AIT) remains controversial. In overtly hypothyroid patients, reductions in thyroid volume have been reported, whereas the effect in subclinically hypothyroid and euthyroid patients is less clear.Objective: The objective of the study was to evaluate the effect of levothyroxine treatment on thyroid size (determined with thyroid ultrasonography) in children and adolescents with AIT.Design and Setting: This study included patients with AIT treated at a university hospital outpatient clinic between 1987 and 2004.Patients: Ninety children with AIT (73 girls and 17 boys, aged 6.1-17.7 yr) were included in the study.Intervention: Intervention was treatment with levothyroxine for a median 2.8 yr (range 0.5-10.2).Main Outcome Measure: Change in thyroid volume SD score (SDS) during the study period was measured.Results: Median thyroid volume SDS was reduced in patients euthyroid (-0.4 SDS, P < 0.001), subclinically hypothyroid (-1.4 SDS, P < 0.001), and overtly hypothyroid (-1.8 SDS, P < 0.002) at diagnosis of AIT. Both hypothyroid and euthyroid patients with goiter ( thyroid volume > 2.0 SDS) at baseline reduced their median thyroid volume SDS (-1.6 and -0.9, respectively, P < 0.001). Hypothyroid patients without goiter also reduced median thyroid volume SDS (-1.2, P < 0.004), whereas no change was noticed in euthyroid children without goiter.Conclusions: Levothyroxine treatment is effective in reducing thyroid volume in pediatric patients and is suggested in treatment of goiter caused by AIT, especially in cases of hypothyroid, but also in euthyroid children.