甲状腺良性结节L-T4抑制性治疗的研究

Investigation on levothyroxine suppressive therapy of benign thyroid nodules

目的评价L-T4抑制性治疗良性甲状腺结节的疗效、量效关系、疗效影响因素及不良反应等。方法以2007.1-2009.9上海交通大学医学院附属第一人民医院住院患者完成甲状腺细针穿刺细胞学检查诊断为良性结节的450例患者为研究对象,分为L-T4抑制性治疗组和对照组。分别于治疗后3、6、9、12月时随诊甲状腺功能和超声结节大小的变化、计算有效率(最大结节容积缩小≥50%)、不良反应发生率。将随访至12月份时治疗组患者分为有效组、无效组,比较两组相关参数差异。结果治疗组在治疗3、6、9、12月时治疗有效率分别为9.9%、28.8%、46.5%、48.3%,而对照组除3月时有3例(4.3%)患者出现最大结节容积缩小≥50%。有效组与无效组比较显示TSH被抑制水平较低(<0.43mIU/L)、结节含大量胶质、基线结节容积较小(<0.53 ml)患者治疗效果较好,而病理上皮细胞为主,B超提示结节钙化者治疗效果欠佳。以上指标两组差异有统计学意义(P<0.05)。结论L-T4抑制性治疗良性甲状腺结节是可选择的有效的方法,但年龄较大患者易发生心悸、失眠等不良反应。TSH抑制值、基线结节容积大小、结节有无钙化、是否含大量胶质、病理是否以上皮细胞为主影响L-T4抑制性治疗的有效性。

bjective： Evaluation the effect, relationship of dose -efficacy, affecting factors and adverse reactions and so on of L - T4 suppressive treatment on benign thyroid nodules. Methods： In this trial, 450 inhospitalized patients with be- nign nodules were included and divided into treatment and control groups. Thyroid function tests, ultrasonographie nodule characteristics ,effective rate and adverse reactions were assessed before treatment and 3, 6, 9and 12 months thereafter. The treatment group were divided into two groups, effective and in effective groups. To compare difference of two group＇s param- eters. Results ： The effective rate was 9.9%, 28.8%, 46.5%, 48.3%. The control group have 3 eases （4.3%） patients who the largest nodule volume narrowing~〉 50% only in March. The patients who TSH 〈0.43 mlU/L,thyroid nodular hav- ing colloid, baseline nodular volume 〈 0.53ml acquired fine therapeutic efficacy,who having dominant endothelial cell, having calcification had bad therapeutic efficacy, and the difference had statistical significance. Others had no statistical sig- nificance. Conclusion： L- T4 suppressive therapy is a effective for benign nodular thyroid, but easily happen palpitation and insomnia and so on in old person. TSH suppressive value, baseline nodular volume, having calcification, having colloid,having dominant endothelial cell affect the efficacy of L- T4 suppressive therapy.