糖皮质激素冲击治疗桥本甲状腺炎伴甲状腺肿大

目的 观察糖皮质激素冲击治疗桥本甲状腺炎（hashimoto thyroiditis,HT）伴甲状腺肿大的疗效.方法 收集郑州大学第一附属医院内分泌科住院确诊的HT 30例,均口服优甲乐,维持FT3、FT4及TSH水平在正常参考值范围3个月后,甲状腺肿大仍较明显,应用甲基强的松龙每次250 mg,每日1次,共7次,后改为口服强的松片10 mg,每日3次,每周减5 mg至停药,共6周.激素冲击治疗前后行甲状腺B超检测.结果 激素冲击治疗后甲状腺左右叶长、宽、厚及峡部明显缩小（P＜0.05）,左叶治疗前后长分别为（57.42±12.87）～（46.37±7.67） mm,t =4.58;宽（26.68 ±7.71） ～ （22.21±6.09） mm,t=4.56;厚（27.18 ±6.60）～（21.14 ±5.67）mm,t =7.28;右叶治疗前后长分别为（58.17±12.32）～（49.73±9.35）mm,t=3.84;宽（26.14 ±7.37）～（23.00 ±6.68）ram,t=3.29;厚（27.57 ±6.42）～ （22.00 ±5.55）mm,=5.88;峡部治疗前后分别为（9.94 ±4.15） ～ （6.19±2.57） mm,t=6.09.1年后随访复发率17％（5/30）.结论 糖皮质激素冲击治疗桥本甲状腺炎并甲状腺肿大疗效显著,复发率低.

Methylprednisolone pulse therapy for Hashimoto thyroiditis complicated with goiter

Objective To assess the efficacy of methylprednisolone （MP）pulse therapy in treatment of Hashimoto thyroiditis（HT） complicated with goiter.Methods 30 patients with HT complicated with goiter participated in the study and received MP pulse therapy.The patients had to be euthyroid for at least 3 months before the date of inclusion with plasma concentrations of thyroid hormones within their reference range.The goiter was still obvious and had no improvement.A dose of 250 mg MP was administered intravenously for seven consecutive days,and then treated with oral prednisone 10 mg,three times per day for 6 weeks with the dosage in each week gradually reduced at 5 mg to none.Ultrasonic was used to measure thyroid size before and after MP treatment.Results The treatment was successful at the end of the trial in all of the 30 patients receiving MP.The thyroid size from length,breadth,thickness to isthmus obviously decreased （P ＜ 0.05）.The length of the left lobe was （57.42 ± 12.87） mm and （46.37 ± 7.67） mm （t =4.58） before and after treatment; The breadth of the left lobe was（26.68 ±7.71） mm and（22.21 ±6.09） mm（t =4.56） before and after treatment; The thickness of the left lobe was （27.18 ± 6.60） mm and （21.14 ± 5.67） mm（t =7.28） before and after treatment.The length of the right lobe was（58.17 ± 12.32）mm and（49.73 ±9.35） mm（t =3.84） before and after treatment; The breadth of the right lobe was （26.14 ± 7.37）mm and （23.00 ± 6.68） mm（t =3.29） before and after treatment ; The thickness of the right lobe was（27.57 ± 6.42）mm and（22.00 ±5.55）（t =5.88）before and after treatment.The isthmus before and after treatment was（9.94 ±4.15）mm and（6.19 ±2.57）mm（t =6.09）.The recurrence rate was 17％ （5/30） after one year.Conclusions MP pulse therapy is an effective treatment for HT complicated with goiter.The recurrence rate is low.