L-T4对结节性甲状腺肿合并胆囊结石的临床研究

Clinical research on left tetraiodothyronine for patients with nodular goiter complicated by cholecystolithiasis

目的：研究左甲状腺素（Left Tetraiodothyronine,L-T4）对结节性甲状腺肿合并胆囊结石患者的临床疗效。方法：收集超声波检查结合触诊/超声引导下FNA诊断为结节性甲状腺肿伴胆囊结石且临床资料完整的病例128人,纳入L-T4治疗组、手术切除＋L-T4治疗组和对照组,采用电化学发光法检测血清促甲状腺激素（Thyroid stimulating hormone,TSH）、总三碘甲状腺原氨酸（Triiodothyronine,TT3）和总甲状腺素（Tetraiodothyronine,TT4）水平,超声波检查甲状腺与胆囊。随访3~5年观察甲状腺功能变化和甲状腺结节与胆囊结石变化。结果：L-T4组和手术切除＋L-T4组伴随治疗时间延长和TT3、TT4水平不断上升而TSH水平不断降低,在治疗后3~5年胆囊结石和甲状腺结节逐渐缩小（P〈0.05）,而以治疗后5年为著（P〈0.01）。结论：外源性补充L-T4是结节性甲状腺肿合并胆囊结石患者的优化治疗选择,可作为传统的甲状腺部分切除术/胆囊切除术的替代治疗方案和手段。

Objective：To explore the clinical effect on left tetraiodothyronine for patients with nodular goiter complicated bycholecystolithiasis.Methods： 128 cases of nodular goiter complicated by cholecystolithiasis diagnosed by ultrasound,palpation/ultrasound-guided FNA,and with completely clinical data,were divided into L-T4 group,surgical resection ＋ L-T4 group and control group,in which the level of serum thyroid stimulating hormone（TSH）,total triiodothyronine（TT3） and total thyroxine（TT4） was respectively detected by electrochemiluminescence assay,thyroid and cholecystolithiasis was respectively examined by ultrasound.The change of thyroid function,thyroid nodule and cholecystolithiasis was respectively observed in 3~5 years of following-up.Results： TT3 and TT4 levels were increase and TSH levels was decreased with three prolonged following-up in L-T4 group and surgical resection ＋ L-T4 group,in which gallstones and thyroid nodules gradually reduced in 3~5 years（P 0.05）,especially in 5 years（P0.01）.Conclusion： Exogenous supplement L-T4 is the alternative treatment for patients with nodular goiter complicated by cholecystolithiasis,which can be alternative treatment scheme and means of traditional partial thyroidectomy / holecystectomy.