M. Grussendorf, TREATMENT OF EUTHYROID IODINE DEFICIENCY GOITER - EFFICACY OF THE COMBINATION OF L-THYOXINE AND 150-MU-G IODINE IN COMPARISON WITH MONO-L-THYROXINE, Medizinische Klinik, 91(8), 1996, pp. 489-493
Background: In terms of the pathomechanism, TSH and intrathyroid iodin
e deficiency are the interconnecting elements between alimentary iodin
e deficiency and the growth and genesis of goiter. L-Thyroxine treatme
nt for suppression of hypophyseal TSH production and supplementary iod
ide have a synergistic effect in reducing the size of goiter. An indiv
idual adaptation of the L-Thyroxine dose is necessary for optimal TSH
suppression. Excessive suppression of the the TSH level prevents uptak
e of iodine by the thyroid and thus compensation of the intrathyroid i
odine deficiency. Combination therapy of an individually adjusted amou
nt of L-Thyroxine with a small, mostly constant amount of iodine is a
recognized concept of goiter therapy today. Administration of a combin
ation preparation with an individually adjustable dose of L-Thyroxine
and 150 mu g iodine complies with these recommendations and improves c
ompliance since only one tablet is required. Patients and Methods: In
the present study, the thyroid iodine supply, efficacy and tolerance o
f such a combination preparation was tested for the first time in 49 p
atients with euthyroid iodine deficiency goiter (group A). 45 patients
receiving an individual L-Thyroxine therapy served as controls (group
B). Results: Supplementation of individually dosable L-Thyroxine with
150 mu g iodide leads to a markedly raised iodine excretion in the ur
ine (p < 0.005). This is an indirect indication of an improved thyroid
iodine supply. Patients of group A showed a greater reduction of the
thyroid volume (18.5% as compared to 16.8%, p = n. s.) and a more pers
istent TSH suppression (lowering by 39% [group A] as compared to a ris
e of 17% [group B]) in relation to the initial value (p < 0.004). This
is attributable to the improved supply of iodine. Conclusion: The com
bination therapy tested was tolerated just as well as the mono-l-Thyro
xine treatment with better efficacy.