Vergleich der Wirksamkeit zweier verschieden dosierter Levothyroxin-Iodid-Kombinationen in der Therapie der euthyreoten diffusen Struma

Kreißl, MC; Tiemann, Markus; Hänscheid, Heribert; Rendl, J.; Reiners, Christoph

doi:10.1055/s-2001-11478

Cited by 17 publications

(3 citation statements)

References 20 publications

(26 reference statements)

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“…At first glance, it seems clear that TSH is the major growth factor of the thyroid gland. Nevertheless, suppressing TSH for a long term so as to decrease the size or arrest the growth of thyroid nodules is still highly controversial ( 36 ). A beneficial effect of thyroid hormones on diffuse goiters has been demonstrated in several controlled trials ( 37 – 39 ).…”

Section: Discussionmentioning

confidence: 99%

Efficacy of Metformin for Benign Thyroid Nodules in Subjects With Insulin Resistance: A Systematic Review and Meta-Analysis

Sui

Zhang

et al. 2018

Front. Endocrinol.

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Background: To evaluate the effect of metformin therapy on decreasing benign thyroid nodule volume in subjects with insulin resistance (IR).Method: Randomized controlled trials (RCTs) and self-controlled trials for the meta-analysis published, before January 31, 2018 were selected from the PubMed, Cochrane Library, Embase, Web of Science, Chinese Biomedical Literature Database, National Knowledge Infrastructure, WANFANG and VIP Database. Pooled standard mean difference with 95% confidence interval was estimated by fixed- or random-effects model depending on heterogeneity. The risk of bias using the Cochrane Collaboration's tool was used to assess the quality of the RCTs contained. The quality of self-controlled studies was evaluated using the Methodological index for non-randomized studies (MINORS) method.Results: 7 studies (3 RCTs and 4 prospective self-controlled studies) with 240 patients were considered to be appropriate for the meta-analysis. The results of the meta-analysis indicated that the volume of thyroid nodule decreased significantly after metformin therapy (SMD −0.62, 95% CI −0.98 ~ −0.27). 6 studies reported the changes of the level of TSH. TSH levels decreased significantly after metformin therapy (SMD −0.27, 95% CI −0.47 ~ −0.07). The pooled data indicated an increase in FT3 level, and an unchanged FT4 level after metformin therapy (FT3, SMD 0.25, 95% CI 0.05 ~ 0.45; FT4, SMD −0.07, 95% CI −0.27 ~ 0.13). HOMA-IR levels decreased significantly after metformin therapy based on the pooled results of 3 RCTs and 3 prospective self-controlled studies (SMD −1.08, 95% CI −1.69 ~ −0.47).Conclusion: The meta-analysis demonstrated that metformin was safe and useful in shrinking benign thyroid nodules volume, improving thyroid function and IR. A large number of high-quality prospective studies still need to be carried out.

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Section: Discussionmentioning

confidence: 99%

Efficacy of Metformin for Benign Thyroid Nodules in Subjects With Insulin Resistance: A Systematic Review and Meta-Analysis

Sui

Zhang

et al. 2018

Front. Endocrinol.

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“…The efficacy of thyroid hormones depends on the degree of TSH suppression [22,25], although results have been conflicting [27]. In some of the studies, in which L-T4 was compared [20,26,27] or combined [20,24,26] with iodine supplementation, no substantial differences were found between the regimens, but L-T4 resulted in a more pronounced depression of serum TSH than did iodine. Comparing nodular and diffuse goitres, the effect of L-T4 is clearly more convincing in diffuse glands [23].…”

Section: L-thyroxine Suppressive Therapymentioning

confidence: 99%

Treatment of Goitre

Bonnema¹,

Hegedüs²

2005

Der Nuklearmediziner

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No consensus exists regarding the optimum treatment of benign non-toxic goitre. L-thyroxine suppressive therapy is widely used for treatment of goitre, but there is poor evidence of its efficacy, and the suppression of serum TSH may have serious adverse effects on health. Iodine supplementation is no better than L-thyroxine in comparative trials. Surgery is first choice in large goitres or if malignancy is suspected. Post-surgery, risk of goitre recurrence is inversely correlated with the extent of the operation. 131 I therapy results in a one-year goitre reduction of around 50 % in multinodular and 70 % in diffuse goitres, usually with a high degree of patient satisfaction and improvement of the inspiratory capacity. The effect is attenuated with increasing goitre size. The risk of hypothyroidism is 22-58 % within 5-8 years. A sufficient thyroid 131 I uptake is mandatory for 131 I therapy to be feasible. Prestimulation with recombinant human TSH (rhTSH) may increase the thyroid 131 I uptake considerably. This leads to an increased absorbed thyroid dose by approx. 75 %, mainly in those patients with the lowest thyroid 131 I uptake. In addition, rhTSH results in a more homogeneous intrathyroidal isotope distribution. Recent studies with rhTSH stimulation before 131 I therapy are encouraging. Pre-stimulation with even a small dose of rhTSH allows a reduction of the 131 I activity while still achieving a mean goitre reduction of approximately 40 % within the first 12 months. A significantly lower extrathyroidal radiation is achieved by this approach. With an unchanged 131 I activity, rhTSH pre-stimulation seems to improve the goitre reduction by up to 50 %. However, this is at the expense of a higher rate of hypothyroidism in addition to other side effects like cervical pain and transient thyrotoxicosis. Of particular concern is the Zusammenfassung Zur optimalen Behandlung der gutartigen euthyreoten Knotenstruma besteht kein Konsens. Die TSH-suppressive Therapie mit Levothyroxin wird zwar sehr häufig zur Behandlung der Struma eingesetzt; ihre Effektivität ist jedoch wenig belegt und die TSHSuppression hat möglicherweise ernsthafte gesundheitliche Nebenwirkungen. Eine Iodsupplementation zeigt in vergleichenden Studien keine besseren Effekte als Levothyroxin. Es besteht Konsens, dass die Operation die Therapie der ersten Wahl bei großen Strumen oder Verdacht auf Malignität ist. Postoperativ ist das Risiko eines Strumarezidivs negativ korreliert mit dem Ausmaß des Eingriffs. Die 131 I-Therapie führt nach einem Jahr zu einer Reduktion des Strumavolumens um rund 50 % bei multinodulären und 70 % in diffusen Strumen, üblicherweise verbunden mit einer Verbesserung der Atemfunktion und der Patientenzufriedenheit; bei zunehmender Strumagröße nimmt dieser positive Effekt jedoch ab. Innerhalb von 5-8 Jahren liegt das Risiko für eine Hypothyreose nach Radioiodtherapie bei 22-58 %. Die Radioiodtherapie setzt einen ausreichenden Schilddrüsen-Uptake von 131 I voraus; eine Stimulation mit rekombinantem humanem TSH (rhTSH) kann diese...

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“…Die Behandlung der euthyreoten Struma mit Kombinationspräparaten aus Levothyroxin und Jodid wurde in den vergangenen Jahren in verschiedenen klinischen Studien untersucht,bei inzwischen insgesamt mehr als 1000 Patienten, bevorzugt erwachsene Patienten mit euthyreoter Struma [1,2,3,5,6,7,8,9,10,14,15,16,17,18]. Eine sehr kleine Zahl klinischer Studien widmet sich denjenigen Patienten, bei denen postoperativ eine Strumarezidivprophylaxe vorzusehen ist sowie der Untersuchung von schwangeren Patientinnen und Kindern.…”

Section: Introductionunclassified

Optimale Rezidivprophylaxe der Jodmangelstruma nach Schilddrüsenoperation

Schumm-Draeger

Encke²,

Usadel³

2003

Internist

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In summary the data of our study show: (1) Sonographically determined thyroid volume of patients with euthyroidism after surgery is found to be significantly lower with a combination therapy (iodide 150 microgram +Levothyroxine 75 microgram) compared to patients with iodide monotherapy (200 microgram). (2) Thyroid volume of patients with hypothyroidism after surgery is found to be significantly lower during a combination therapy (150 microgram iodide + 75 microgram L-thyroxine) compared to patients with a Levothyroxine monotherapy. (3) Patients with hypothyroidism and Levothyroxine monotherapy, however present with a significant increase of thyroid volume after surgery. (4) Urinary iodide excretion in the treatment groups with iodide or combination therapy increases significantly during therapy, however, patients with Levothyroxine monotherapy do not show changes. (5) Thyroid function is well stabilized in all treatment groups with adequate controls and adjustment of Levothyoxine dosage. There data clearly demonstrate that the combination therapy with Levothyoxine and iodide significantly improves prophylaxis of goiter recurrence.

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Vergleich der Wirksamkeit zweier verschieden dosierter Levothyroxin-Iodid-Kombinationen in der Therapie der euthyreoten diffusen Struma

Cited by 17 publications

References 20 publications

Efficacy of Metformin for Benign Thyroid Nodules in Subjects With Insulin Resistance: A Systematic Review and Meta-Analysis

Efficacy of Metformin for Benign Thyroid Nodules in Subjects With Insulin Resistance: A Systematic Review and Meta-Analysis

Treatment of Goitre

Optimale Rezidivprophylaxe der Jodmangelstruma nach Schilddrüsenoperation

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