地塞米松局部治疗对桥本甲状腺功能减退症患者甲状腺的影响

目的了解甲状腺局部地塞米松注射治疗对桥本甲状腺功能减退症（甲减）患者短、长期甲状腺结构和功能的影响。方法60例经甲状腺细针穿刺及甲状腺功能检查确诊为桥本甲减患者，随机分为优甲乐（L—T4）组和L-T4＋地塞米松局部治疗组，各30例。分别予以L—T4或L—T4＋地塞米松局部治疗（地塞米松5mg，甲状腺局部注射qod，共7次）。治疗结束后观察甲状腺功能，L—T4用药剂量，甲状腺前后径和峡部的厚度，甲状腺淋巴细胞浸润和甲状腺滤泡的变化。治疗前、治疗后4、12、24周、1年随访测定。结果L—T4组替代治疗后甲状腺功能恢复正常，但患者需终生服药，且多数患者颈粗症状无明显改善；L—T4＋地塞米松局部治疗组甲状腺功能正常后L—T4减量或逐渐停药，肿大的甲状腺明显缩小，甲状腺细针穿刺淋巴细胞明显减少。结论局部地塞米松注射治疗可改善桥本甲减患者甲状腺的结构和功能，减少L-T4替代剂量。

Effects of local injection of dexamethasone on structure and function of thyroid in patients with Hashimoto thyroiditis

Objective To study the effects of dexamethasone local injection as an adjunctive therapy for Hashimoto thyroiditis (HT). Methods 60 HT cases were equally divided into 2 groups at random. The patients in the control group were given euthyrpx while the patients in the treated group were injected dexamethasone in addition to the medicine used in the control group. The thyroid characters such as thickness, lymphocytic infiltration and changes of thyroid follicle were observed. The patients were followed up before treatment and 4, 12, 24weeks and 1 year after treatment. Results In the treatment group, all thyroid glands turned significantly softer,and the mass became smaller compared with that in the control group. The pathology of thyroids indicated that lymphocytic infiltration decreased, local immune reaction was ameliorated, and no obvious hormone side effects were observed. Conclusion Local use of dexamethasone can modify the structure and function of thyroid.