Treatment of endemic goitre due to iodine deficiency with iodine, levothyroxine or both: results of a multicentre trial

Abstract

Preliminary clinical studies and recent in vitro investigations suggest that iodine administration may be an effective alternative in the treatment of the diffuse euthyroid goitre of iodine deficiency. Therefore a 12-month multicentre study was initiated in which 166 patients were randomly assigned to take either 150 micrograms levothyroxine day-1 (group A, n = 61), 400 micrograms iodine day-1 (group B, n = 50), or a combination of 75 micrograms levothyroxine and 200 micrograms iodine day-1 (group C, n = 55) for 8 months with follow-up examinations at 4 and 8 months as well as 4 months after cessation of treatment. Initially, thyroid volume, as determined by ultrasound, was not significantly different in the three groups. In all three groups, during treatment a significant and comparable mean decrease in goitre size was documented (-32.1% in group A, -37.3% in group B, -38.7% in group C). After cessation of treatment in group A mean thyroid volume again increased to near the baseline value (-12.0% compared to the initial investigation), while the therapeutic effect was sustained in group B (-32.5%). In group C, only a slight rebound effect was observed (-26.3% vs baseline volume). Total thyroxine (T4) increased sharply and significantly in group A from 7.8 +/- 1.9 to 10.9 +/- 2.8 micrograms dl-1 after 8 months (P less than 0.001), but only slightly, although significantly in group B (from 7.8 +/- 1.5 micrograms dl-1 to 8.9 +/- 1.6 micrograms dl-1; P less than 0.02).(ABSTRACT TRUNCATED AT 250 WORDS)

Unaltered pulsatile and circadian TSH release in euthyroid patients with endemic goitre

“…Actually, it could, however, not be differentiated whether the suppression of the pituitary TSH secretion itself or the iodine content of thyroxine acted on the thyroid volume. The treatment of non-toxic goitre with 400 pg iodine daily alone decreased goitre size comparable to the effect revealed by a thyroxine therapy (13). Indeed, there seems to be little evidence that TSH could be an important factor for goitrogenesis.…”

Rolle der totalen Thyreoidektomie im primären Therapiekonzept der benignen Knotenstruma

“…Andere Autoren berichten über ähnliche Rezidivraten, wobei die Inzidenz der Rezidivstruma nach postoperativer medikamentöser Prophylaxe mit L-Thyroxin zwischen 0% und 14,5%, ohne medikamentöse Rezidivprophylaxe zwischen 10,7% und 43% lag [1,4,12,26]. Der direkte Zusammenhang zwischen einer TSHsuppressiven Schilddrüsenhormonsubstitution und der Minderung der Rezidivrate wird jedoch von vielen Autoren nicht geteilt [2,12,14,18,44].Aufgrund der Pathophysiologie der Rezidivstruma gilt die Jodsubstitution zur Rezidivprophylaxe in Jodmangelgebieten seit gut 20 Jahren als allgemein anerkannt [10,19,20,28,33].Andere Arbeitsgruppen [14] führten die Strumarezidive auf die Produktion von "insulin-like growth factor" (IGF-1) und "epidermal growth factor" (EGF) des verbliebenen Schilddrüsenrestes zurück. Insgesamt gilt, dass in einem Jodmangelgebiet ohne postoperative Prophylaxe eine höhere Rezidivrate als in einem ausreichend mit Jod versorgtem Gebiet zu erwarten ist und dass das Strumarezidivrisiko von der Radikalität des Ersteingriffes und von der Qualität des verbliebenen Restschilddrüsenparenchyms abhängt [9].…”

Interobserver and intraobserver variations in sonographic measurement of thyroid volume in children

“…This method is also used to determine thyroid size in both diagnosis and follow-up of patients with diseases that could affect the thyroid gland (1)(2)(3)(4)(5)(6)(7)(8)(9)(10). Normal ranges of thyroid volumes in pediatric age groups and adults have been published in many references, and may be a guide to decide whether thyroid size is normal or not (11)(12)(13)(14)(15).…”