Лечение узлов щитовидной железы
Добавлено: Вс мар 15, 2009 1:58 pm
Похоже, скоро вместо тироксина
узлы будут лечить метформином. Опять же, двойная польза, может и диабет отодвинем подальше
METFORMIN TREATMENT OF BENIGN THYROID NODULES IN EUTHYROID PATIENTS WITH INSULIN RESISTANCE
J. Rezzonico, M. Rezzonico, E. Pusiol, F. Pitoia, H. Niepomniszcze
Centro Privado de Endocrinologýa, Mendoza, and Division of Endocrinology, Hospital de Clýnicas – University of Buenos Aires, Buenos Aires, Argentina.
Since we have already shown that patients with insulin resistance (IR) have a high prevalence of thyroid nodules (Thyroid, 18: 461-464, 2008), a prospective and randomized study was performed to evaluate the ability of metformin for reducing the nodular size. Four groups of women with IR and nodular hyperplasia, diagnosed by FNA biopsy, were included in this protocol. The four groups were: G1 (n=14), patients only treated with metformin; G2 (n=18 ), patients treated with metformin plus L-T4; G3 (n=19), patients treated only with L-T4; G4 (n=15) patients without any treatment (control group). In groups G2 and G3, L-T4 treatment was maintained for 6 months. During the same period of time, groups G1 and G2 received metformin, 1g per day. The original volumes of the nodules, measured by U.S., had a mean value of 0.53 ml, ranging between 0.03 and 3.6 ml. The L-T4 dose was adjusted to keep a serum TSH level not lower than 0.1 and no greater than 0.9 µU/ml. Metformin was given twice a day. Results have shown that the percentages of reduced nodules were as follows: G1= 73.7%, G2=95.2%, G3=35%, G4=26.7%, while the modification of the original nodular volume, considered as the mean of the whole group, was: G1= -35%, G2= -70%, G3= 0%, G4= +114%. It is concluded that in patients with IR and small thyroid nodules, metformin produced a significant decrease of the nodular size. The combination of metformin with L-T4 was the best treatment in these women. L-T4 alone only prevented the nodular growth, but had no effect in reducing the nodular volume. Since TSH and insulin are thyroid growth factors, the combined treatment, which decreased the serum levels of both hormones, appears to be a very good therapeutic tool in these patients.
узлы будут лечить метформином. Опять же, двойная польза, может и диабет отодвинем подальше
METFORMIN TREATMENT OF BENIGN THYROID NODULES IN EUTHYROID PATIENTS WITH INSULIN RESISTANCE
J. Rezzonico, M. Rezzonico, E. Pusiol, F. Pitoia, H. Niepomniszcze
Centro Privado de Endocrinologýa, Mendoza, and Division of Endocrinology, Hospital de Clýnicas – University of Buenos Aires, Buenos Aires, Argentina.
Since we have already shown that patients with insulin resistance (IR) have a high prevalence of thyroid nodules (Thyroid, 18: 461-464, 2008), a prospective and randomized study was performed to evaluate the ability of metformin for reducing the nodular size. Four groups of women with IR and nodular hyperplasia, diagnosed by FNA biopsy, were included in this protocol. The four groups were: G1 (n=14), patients only treated with metformin; G2 (n=18 ), patients treated with metformin plus L-T4; G3 (n=19), patients treated only with L-T4; G4 (n=15) patients without any treatment (control group). In groups G2 and G3, L-T4 treatment was maintained for 6 months. During the same period of time, groups G1 and G2 received metformin, 1g per day. The original volumes of the nodules, measured by U.S., had a mean value of 0.53 ml, ranging between 0.03 and 3.6 ml. The L-T4 dose was adjusted to keep a serum TSH level not lower than 0.1 and no greater than 0.9 µU/ml. Metformin was given twice a day. Results have shown that the percentages of reduced nodules were as follows: G1= 73.7%, G2=95.2%, G3=35%, G4=26.7%, while the modification of the original nodular volume, considered as the mean of the whole group, was: G1= -35%, G2= -70%, G3= 0%, G4= +114%. It is concluded that in patients with IR and small thyroid nodules, metformin produced a significant decrease of the nodular size. The combination of metformin with L-T4 was the best treatment in these women. L-T4 alone only prevented the nodular growth, but had no effect in reducing the nodular volume. Since TSH and insulin are thyroid growth factors, the combined treatment, which decreased the serum levels of both hormones, appears to be a very good therapeutic tool in these patients.