Pharmacotherapy for thyroid nodules - A systematic review and meta-analysis
Pharmacotherapy for thyroid nodules - A systematic review and meta-analysis
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DOI：
10.1016/s0889-8529(02)00010-5
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发表时间：
2002-09-01
影响因子：
4.5
通讯作者：
Clar, C
中科院分区：
文献类型：
--
作者：
Richter, B;Neises, G;Clar, C
临床医生使用左旋甲状腺素来抑制促甲状腺激素（TSH）的产生，阻止甲状腺结节的生长或缩小甲状腺结节的大小。临床试验测试这种干预措施的有效性报告相互矛盾的结果。确定左旋甲状腺素抑制治疗对结节大小和生长、甲状腺激素水平和不良反应的影响。我们检索了科克伦图书馆（2001年第4期）和Medline（1966年至2001年10月），使用一种策略来识别临床试验和甲状腺结节。我们检查了书籍章节、社论、叙述性评论和合格研究的参考文献列表。我们纳入了研究使用左旋甲状腺素抑制TSH对良性孤立性甲状腺结节的影响的随机对照试验，两位评论者独立选择了这些研究，评估了它们的方法学质量，并使用标准化表格提取了有关参与者、干预措施和结局的数据。我们发现9项研究（596例患者）与我们的问题相关。甲状腺素和TSH在左旋甲状腺素抑制治疗后显著改变，表明对干预的依从性良好。甲状腺素抑制治疗导致治疗应答率无显著改善（定义为超声检查甲状腺结节体积缩小≥ 50%）（合并相对风险1.83，95%置信区间0.90-3.73）。研究很少观察到不良反应。TSH抑制治疗可抑制甲状腺孤立性结节的生长并缩小结节大小。这种治疗对患者重要结局的影响的不确定性使人们对使用甲状腺素抑制治疗的明智性产生了相当大的怀疑。我们需要更大规模和更长时间的高质量研究来评估TSH抑制治疗对以患者为导向的结果的影响，如甲状腺癌发病率，生活质量，长期不良反应和成本。
Clinicians use levothyroxine to supress thyroid-stimulating hormone (TSH) production and arrest growth or reduce the size of thyroid nodules. Clinical trials testing the efficacy of this intervention report conflicting results. To determine the impact of levothyroxine suppressive therapy on nodule size and growth, thyroid hormone levels, and adverse effects. We searched the Cochrane Library (issue 4, 2001) and Medline (1966 to October, 2001) using a strategy to identify clinical trials and thyroid nodules. We examined book chapters, editorials, and narrative reviews and the reference lists from eligible studies. We included randomized controlled trials that studied the effects of TSH suppression using levothyroxine on benign solitary thyroid nodules, Two reviewers independently selected the studies, evaluated their methodologic quality, and extracted data about participants, interventions, and outcomes using a standardized form. We found nine studies (596 patients) relevant to our question. Thyroxine and TSH changed significantly after levothyroxine suppressive therapy indicating good compliance with the intervention. Thyroxine suppressive therapy led to a nonsignificant improvement in the rate of response to therapy (defined as greater than or equal to 50% reduction in thyroid nodule volume by ultrasonography) (pooled relative risk 1.83, 95% confidence interval 0.90-3.73). Studies rarely observed adverse effects. TSH suppression therapy inhibits solitary thyroid nodule growth and reduces nodule size. Uncertainty about the impact of this therapy on outcomes that are important to patients leaves considerable doubts about the wisdom of using thyroxine suppressive therapy. We need larger and longer high-quality studies assessing the effects of TSH suppression therapy on patient-oriented outcomes such as thyroid cancer incidence, quality of life, long-term adverse effects, and costs.