Effects of GH replacement therapy on thyroid volume and nodule development in GH deficient adults: a retrospective cohort study
Effects of GH replacement therapy on thyroid volume and nodule development in GH deficient adults: a retrospective cohort study
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DOI：
10.1530/eje-14-0966
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发表时间：
2015-05-01
影响因子：
5.8
通讯作者：
Ruggeri, Rosaria Maddalena
中科院分区：
文献类型：
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作者：
Curto, Lorenzo;Giovinazzo, Salvatore;Ruggeri, Rosaria Maddalena
目的：尽管GH/IGF 1信号对甲状腺的影响是众所周知的，但关于GH替代治疗（GHRT）期间低血糖受试者发生结节性甲状腺肿的风险的数据很少。我们的目的是定义GH治疗对甲状腺体积（TV）和结节growth.Design的影响：96例（47名男性和49名女性，中位年龄48岁）GH缺陷（GHD）的记录进行了调查。70人还患有中枢性甲状腺功能减退症（CH）。在我们的回顾性评价的时间，中位治疗时间为5 years.Results：治疗前TV小于GHD患者比健康受试者（P=0.030）。在GH治疗期间，TV显著增加（整个组P=0.016，甲状腺功能正常的GHD患者P=0.014）。在开始GH治疗前，17例患者患有甲状腺结节。在GH治疗期间，7例患者的结节大小略有增加，9例患者出现新的甲状腺结节。在79名先前没有甲状腺结节的患者中，17名患者出现了一个或多个结节。GHD伴或不伴甲状腺结节患者CH患病率无差异（P=0.915; P=0.841，排除治疗前结节性甲状腺肿患者），结节发生的主要预测因子是血清IGF 1（P=0.038）。27%的患者出现甲状腺结节，主要与治疗前IGF 1水平有关，与正常或受损的TSH刺激无关。
Objective: Despite the well-known effects of GH/IGF1 signaling on the thyroid, few data are available on the risk of developing nodular goiter in hypopituitary subjects during GH replacement therapy (GHRT). We aimed to define the effects of GH therapy on thyroid volume (TV) and nodular growth.Design: The records of 96 subjects (47 males and 49 females, median age 48 years) with GH deficit (GHD) were investigated. Seventy also had central hypothyroidism (CH). At the time of our retrospective evaluation, median treatment duration was 5 years.Results: Pre-treatment TV was smaller in GHD patients than in healthy subjects (P=0.030). During GH treatment, TV significantly increased (P=0.016 for the entire group and P=0.014 in euthyroid GHD patients). Before starting GH therapy, 17 patients harbored thyroid nodules. During GH therapy, nodule size increased slightly in seven patients, and new thyroid nodules occurred in nine patients. Among the 79 patients without pre-existing thyroid nodules, 17 developed one or more nodules. There was no difference in the prevalence of CH in GHD patients with or without thyroid nodules (P=0.915; P=0.841, when patients with pre-therapy nodular goiter were excluded), the main predictor for nodule development being serum IGF1 (P=0.038).Conclusions: GHRT is associated with TV's increase in GHD patients. Thyroid nodules developed in 27% of patients, mainly in relation to pre-therapy IGF1 levels, independently of normal or impaired TSH stimulation.