Long-term changes in nodular goiter: A 5-year prospective randomized trial of levothyroxine suppressive therapy for benign cold thyroid nodules
Long-term changes in nodular goiter: A 5-year prospective randomized trial of levothyroxine suppressive therapy for benign cold thyroid nodules
复制标题
DOI：
10.1210/jc.83.3.780
复制
发表时间：
1998-03-01
影响因子：
5.8
通讯作者：
Pacella, CM
中科院分区：
文献类型：
--
作者：
Papini, E;Petrucci, L;Pacella, CM
我们对83名患者进行了5年的同质性研究，随机分为左旋甲状腺素（L-T-4）抑制治疗组和对照组，以评估结节或甲状腺大小的变化、新结节的出现以及与临床参数的相关性。1.46+/- 0.77 mt），而在治疗组中，其降低，尽管不显著（1.45 +/- 1.17 mt vs. 1.53 +/- 0.61 mt）。两组的基线结节体积没有差异，但在5年时观察到显著差异。5年后，超声检查发现对照组有12个新结节（28.5%），治疗组有3个（7.5%）。TSH完全抑制的患者更常出现脑萎缩，但与其他参数无关。总之，长期TSH抑制仅在一个亚组甲状腺结节中引起体积减小，但有效地防止了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史的变化与长期的TSH抑制有关，这可能会引起不利的副作用，因此应保留L-T-4抑制疗法用于年轻患者的小结节。
We studied for 5 yr a homogeneous group of 83 patients randomly assigned to a levothyroxine (L-T-4) 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 us. 1.46 +/- 0.77 mt), whereas in the treatment group it decreased, although not significantly (1.45 +/- 1.17 mt vs. 1.53 +/- 0.61 mt). 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-T-4 suppressive therapy should be reserved for small nodules in younger patients.