地塞米松治疗桥本甲状腺炎的临床价值

目的 观察口服左旋甲状腺素钠（1evothyroxine，LT）联合甲状腺内注射地塞米松磷酸钠（DX）治疗亚临床甲状腺功能减退（SCH）的桥本甲状腺炎（HT）的疗效。方法80例伴SCH的HT患者随机分为LT组40例和DX组40例。两组于治疗前及治疗后测定游离甲状腺素（FT4）、游离三碘甲状腺原氨酸（FT3）、高敏促甲状腺激素（sTSH）、抗甲状腺球蛋白抗体（TGAb）、抗甲状腺过氧化物酶抗体（TPOAb）、皮质醇（Cortisol）、促肾上腺皮质激素（ACTH）等含量。结果两组治疗后FT3、FT4含量较治疗前升高（t=2．123，P〈0．05；t=2．210，P〈0．05），sTSH含量较治疗前下降（t=2．183，P〈0．05）。两组治疗后血清TPOAb、TGAb水平较治疗前下降（t=2．198，P〈0．05；t=2．230，P〈0．05）。DX组sTSH含量下降更明显。两组治疗后甲状腺体积较治疗前缩小，DX组缩小更明显。颈部外观积分及压迫症状均下降，DX组积分下降更明显。DX组在缩小甲状腺肿、降低甲状腺自身抗体滴度及改善颈部外观、压迫症状等方面均优于LT组。结论口服LT联合甲状腺内注射DX治疗HT患者明显优于单用LT。

Effect of dexamethasone on conversion of subclinical hypothyroidism caused hy Hashimoto's thyroiditis

Objective To evaluate the effect of oral levothyroxine plus intrathyroidal injection of dexamethasone on conversion of subclinical hypothroidism caused by Hashimoto's thyroiditis.Methods 80 subjects with Hashimoto thyroiditis were randomly divided into 2 groups.Subjects in levothyroxine group(40 cases) were treated with oral levothyroxine sodium,subjects in dexamethasone group(40 cases) were treated with oral levothyroxine plus intrathyroidal injection of dexamethasone.Serum free triiodothyronine(FT_3),free thyroxine(FT_4),sentient thyrotropin(sTSH) and other parameters were evaluated before treatment and after treatment in patients with Hashimoto's thyroiditis.Results The content of FT_3,FT_4 after treatment were obviously higher than that before treatment(t=2.123,P<0.05;t=2.210,P<0.05).The content of sTSH after treatment were obviously lower than that before treatment in two group(t=2.183,P<0.05);The content of thyroid peroxidase antibody(TPOAb),thyroglobulin antibody(TGAb) after treatment were obviously lower than that before treatment in two group(t=2.198,P<0.05;t=2.230,P<0.05);The volume of thyroid after treatment were reduced than that before treatment in two group;Levothyroxine plus dexamethasone therapy proved more effectively in shrinking goiter and in proving pressure symptom and cosmetic symptom on neck and reducing of titration thyroid selfantibod in serum.No major side effects occurred in both groups.Conclusion Levothyroxine plus dexamethasone therapy greatly reduces the incidence of overt hypothroidism,which may be associated with icvothyroxine replacement therapy caused thyroid follicle cell rest and dexamcthasone therapy caused autoimmunity.