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Exp Clin Endocrinol Diabetes 2004; 112(5): 225-230
DOI: 10.1055/s-2004-817967
Article

J. A. Barth Verlag in Georg Thieme Verlag KG Stuttgart · New York

Impact of Disease Activity on Thyroid Diseases in Patients with Acromegaly: Basal Evaluation and Follow-up

B. L. Herrmann1 , H. Baumann1 , O. E. Janssen1 , R. Görges2 , K. W. Schmid3 , K. Mann1
  • 1Clinic of Endocrinology, University of Essen, Germany
  • 2Clinic of Nuclear Medicine, University of Essen, Germany
  • 3Clinic of Pathology, University of Essen, Germany
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Publication History

Received: June 2, 2003 First decision: July 7, 2003

Accepted: October 6, 2003

Publication Date:
14 May 2004 (online)

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Abstract

In patients with acromegaly, the exact incidence of thyroid disorders is still controversial and less is known about the impact of disease activity and successful treatment. To address this issue, we investigated 73 acromegalic patients (age 55 ± 13 yr; mean ± SD) by ultrasonography in comparison to an age-matched control group (54 ± 1 yr) in the same moderate iodine deficient area (retrospective study). These non-acromegalic volunteers (n = 199) were examined in the same clinic during a thyroid screening test. At the time of examination, 52 (71.2 %) of the acromegalic patients were active, 17 (23.3 %) were cured, and 4 (5.5 %) were controlled with somatostatin analogues. The prevalence of goiter (normal range < 18 ml female, < 25 ml male) was significantly higher (82.2 %) in the mixed group of acromegalics (active, well controlled, cured; n = 73) and in the active group (90.4 %) than in the control group (n = 199, 18.1 %, p < 0.001). Thyroid nodules were found in 63.0 % of the mixed group of acromegalics and in 71.2 % of patients with active disease (33.1 % in controls, p < 0.001). 99 mTc scintigraphy revealed thyroid autonomy in 9/73 (12.3 %) and cold nodules in 19/73 (26.0 %) patients. Thyroid cancer was diagnosed in 4 (5.5 %) of acromegalic patients (3 papillary and 1 follicular carcinoma). We found a weak correlation between the disease duration and the initial thyroid volume (r = 0.54, p < 0.0056).

Thirty-seven newly diagnosed acromegalics were followed over a period of 7.3 ± 4.1 years. 5 (13.5 %) of these patients remained active, 8 (21.6 %) were controlled with somatostatin analogues, and 24 (64.9 %) were cured. The mean age, sex distribution, disease duration, prevalence of TSH-deficiency, and initial thyroid volume (46 ± 11 ml in active, 42 ± 7 ml in controlled, and 45 ± 5 ml in cured patients) did not differ statistically between the three groups. In patients with active acromegaly, thyroid volume increased by 19.5 ± 8.1 %. In contrast, thyroid volume decreased in the group of medically controlled and cured acromegalics (- 21.5 ± 7.1 %; p < 0.005 and - 24.2 ± 5.7 %; p < 0.002, respectively). No correlation was found between thyroid volume and TSH levels, levothyroxine and/or iodide administration neither in TSH sufficient nor in TSH insufficient patients.

In conclusion, successful treatment of patients with active acromegaly decreases thyroid volume. Cold nodules and thyroid cancer frequently occur in acromegalic patients.

Key words

Acromegaly - thyroid diseases - disease activity

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M. D. Burkhard L. Herrmann

Clinic of Endocrinology
Center of Internal Medicine
University of Essen

Hufelandstraße 55

45122 Essen

Germany

Phone: + 492017232821

Fax: + 49 20 17 23 59 72

Email: burkhard.herrmann@uni-essen.de

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