Рецепт. 2019; : 471-485
Синдром гипотиреоза в практике интерниста
Аннотация
На основании данных по распространенности гипотиреоза определена его значимость для интернистов с позиций негативного влияния на здоровье. Приведены особенности клинических проявлений заболевания и сложности клинической диагностики в практике врачей различных специальностей.
На основании современных международных руководств, определены особенности и принципы диагностики манифестного и субклинического гипотиреоза.
Приведен анализ данных по оценке факторов, способных оказывать влияние на функцию щитовидной железы, что затрудняет диагностику, а также изложены принципы лечения синдрома гипотиреоза и мониторинга заместительной терапии.
Изложены подходы к диагностике и лечению субклинического гипотиреоза в зависимости от возраста пациента. Отдельное внимание уделено оценке функции щитовидной железы при планировании и ведении беременности.
Список литературы
1. Yu Ning, Yun J, Cheng et al. (2017) What is the association of hypothyroidism with risks of cardiovascular events and mortality? A meta-analysis of 55 cohort studies involving 1,898,314 participants. BMC Medicine, vol. 15(1), pp. 21.
2. Andersen S., Henrik Bruun N., Michael Pedersen K., Laurberg P. (2003) Biologic Variation is Important for Interpretation of Thyroid Function Tests. Thyroid, vol. 13 (11), pp. 1069–1078.
3. Zimmermann M.B., Boelaert K. (2015) Iodine deficiency and thyroid disorders. Lancet Diabetes Endocrinol., vol. 3(4), pp. 286–295.
4. Asvold B.O., Bjøro T., Nilsen T.I., Vatten L.J. (2007) Tobacco smoking and thyroid function: a population-based study. Arch Intern Med., vol. 167(13), pp. 1428–1432.
5. Jonklaas J., Razvi S. (2019) Reference intervals in the diagnosis of thyroid dysfunction: treating patients not numbers. Lancet Diabetes Endocrinol. pii: S2213-8587(18)30371-1.
6. Wu Q., Rayman M.P., Lv H., et al. (2015) Low population selenium status is associated with increased prevalence of thyroid disease. JCEM, vol. 100, pp. 4037–4047.
7. Chaker L., Bianco A.C., Jonklaas J., Peeters R.P. (2017) Hypothyroidism. Lancet, vol. 390, pp. 1550–1562.
8. Rajput R., Chatterjee S., Rajput M. (2011) Can levothyroxine be taken as evening dose? Comparative evaluation of morning versus evening dose of levothyroxine in treatment of hypothyroidism. J. Thyroid Res.
9. Canaris G.J., Manowitz N.R., Mayor G., Ridgway E.C. (2000) The Colorado thyroid disease prevalence study. Arch Intern Med., vol. 160 (4), pp. 526–534.
10. Reed H.L. (1995) Circannual changes in thyroid hormone physiology: the role of cold environmental temperatures. Arctic Med Res., vol. 54, Suppl 2, pp. 9–15.
11. Gullo D., Latina A., Frasca F. et al. (2017) Seasonal variations in TSH serum levels in athyreotic patients under L-thyroxine replacement monotherapy. Clin Endocrinol (Oxf)., vol. 87(2), pp. 207–215.
12. Wiersinga W.M., Duntas L., Fadeyev V., Nygaard B., Vanderpump M.P. (2012) 2012 ETA Guidelines: The Use of L-T4 + L-T3 in the Treatment of Hypothyroidism. Eur Thyroid J., vol. 1(2), pp. 55–71.
13. Samuels M.H., Schuff K.G., Carlson N.E., Carello P., Janowsky J.S. (2007) Health status, psychological symptoms, mood, and cognition in L-thyroxine treated hypothyroid subjects. Thyroid, vol. 17, pp. 249–258.
14. Taylor P.N., Panicker V., Sayers A., Shields B. et al. (2011) A meta-analysis of the associations between common variation in the PDE8B gene and thyroid hormone parameters, including assessment of longitudinal stability of associations over time and effect of thyroid hormone replacement. Eur J. Endocrinol., vol. 164(5), pp. 773–780.
15. Siegmund W., Spieker K., Weike A.I., Giessmann T. et al. (2004) Replacement therapy with levothyroxine plus triiodothyronine (bioavailable molar ratio 14: 1) is not superior to thyroxine alone to improve well-being and cognitive performance in hypothyroidism. Clin Endocrinol (Oxf)., vol. 60(6), pp. 750–757.
16. Jonklaas J., Bianco A.C., Bauer A.J., Burman K.B. et al. (2014) Guidelines for the Treatment of Hypothyroidism: Prepared by the American Thyroid Association Task Force on Thyroid Hormone Replacement. Thyroid Vol., vol. 24 (12), pp. 1670–1750.
17. Koehler V.F., Reincke M., Spitzweg C. (2018) Hypothyroidism-when and how to treat? Internist (Berl), vol. 59 (7), pp. 644–653.
18. Ochs N., Auer R., Bauer D.C., Nanchen D. et al. (2008) Meta-analysis: Subclinical Thyroid Dysfunction and the Risk for Coronary Heart Disease and Mortality. Ann Intern Med., vol. 148(11), pp. 832–845.
19. Walsh J.P., Bremner A.P., Bulsara M.K., O’Leary P. et al. (2005) Subclinical thyroid dysfunction as a risk factor for cardiovascular disease. Arch Intern Med., vol. 165 (21), pp. 2467–2472.
20. Chen H.S., Wu T.E., Jap T.S., Lu R.A. et al. (2007) Subclinical hypothyroidism is a risk factor for nephropathy and cardiovascular diseases in Type 2 diabetic patients. Diabet Med., vol. 24 (12), pp. 1336–1344.
21. Gencer B., Rodondi N. (2016) Evidence and controversies regarding the screening for subclinical hypothyroidism in patients with cardiovascular disease. JTD, vol. 8 (6), pp. E 446–450.
22. Pearce S.H.S., Brabant G. J-L. Wemenau et al. (2014 ) ETA Guideline: Management of Subclinical Hypothyroidism. European Thyroid Journal, vol. 2 (4), pp. 215–228.
23. Jebasingh K.F., Naik D. (2018) Thomas N Subclinical hypothyroidism. Current Medical Issues; vol. 16 (2), pp. 39–41.
24. Rodondi N., den Elzen W.P., Bauer D.C., et al. (2010) Thyroid Studies Collaboration.Subclinical hypothyroidism and the risk of coronary heart disease and mortality. JAMA, vol. 304 (12), pp. 1365–1374.
25. Pearce S.H., Razvi S., Yadegarfar M.E., Martin-Ruiz C. et al. (2016) Serum Thyroid Function, Mortality and Disability in Advanced Old Age: The Newcastle 85+ Study. JCEM, vol. 101(11), pp. 4385–4394.
26. Stott D.J., Rodondi N., Kearney P.M., Ford I. et al. (2017) For the TRUST Study Group Thyroid Hormone Therapy for Older Adults with Subclinical Hypothyroidism. NEJM, vol. 376, pp. 2534–2544.
27. Pearce S.H.S., Brabant G. J-L. Wemenau et al. (2013) ETA Guideline: Management of Subclinical Hypothyroidism. European Thyroid Journal, vol. 2 (4), pp. 215–228.
28. Fadeev V.V. (2010) Zamestitel’naya terapiya gipotireoza: nereshennie problemi ili predrassudki proshlogo (klinicheskoe esse) [Hypothyroidism replacement therapy: unresolved problems or prejudices of the past (clinical essay)]. Klinicheskaya i eksperimental’naya tireoidologiya [Clinical and experimental thyroidology], vol. 6, no 2, pp. 3–10.
29. Alexander E.K., Pearce E.N., Brent G.A., Brown R.S., et al. (2017) Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and the Postpartum. Thyroid, vol. 27 (3), pp. 315–389. https://doi.org/10.1089/thy.2016.0457
30. Chaker L., Bianco A.C., Jonklaas J., Peeters R.P. (2017) Hypothyroidism. Lancet, vol. 390, pp. 1550–1562.
31. Persani L., Brabant G., Dattani M. et al. (2018) European Thyroid Association (ETA) Guidelines on the Diagnosis and Management of Central Hypothyroidism. Eur Thyroid J., vol. 7, pp. 225–237.
32. Wiersinga W.M. (2017) Therapy of endocrine disease: T4 + T3 combination therapy: is there a true effect? Eur J. Endocrinol., vol. 177(6), pp. R287–R296.
Recipe. 2019; : 471-485
Hypothyroidism Syndrome in the Practice of Internist
Abstract
On the basis of data on the prevalence of hypothyroidism and determined its importance for interns from the standpoint of the negative impact on health. The features of clinical manifestations of the disease and the complexity of clinical diagnosis in the practice of doctors of various specialties.
According to modern international guidelines, the features of the diagnosis of manifest and subclinical hypothyroidism are determined.
The analysis of data on the assessment of factors that can affect the function of the thyroid gland, which complicates the diagnosis, as well as the principles of its treatment and monitoring of replacement therapy.
Approaches to the diagnosis and treatment of subclinical hypothyroidism depending on the patient’s age are presented. Special attention is paid to the evaluation of thyroid function in the planning and management of pregnancy.
References
1. Yu Ning, Yun J, Cheng et al. (2017) What is the association of hypothyroidism with risks of cardiovascular events and mortality? A meta-analysis of 55 cohort studies involving 1,898,314 participants. BMC Medicine, vol. 15(1), pp. 21.
2. Andersen S., Henrik Bruun N., Michael Pedersen K., Laurberg P. (2003) Biologic Variation is Important for Interpretation of Thyroid Function Tests. Thyroid, vol. 13 (11), pp. 1069–1078.
3. Zimmermann M.B., Boelaert K. (2015) Iodine deficiency and thyroid disorders. Lancet Diabetes Endocrinol., vol. 3(4), pp. 286–295.
4. Asvold B.O., Bjøro T., Nilsen T.I., Vatten L.J. (2007) Tobacco smoking and thyroid function: a population-based study. Arch Intern Med., vol. 167(13), pp. 1428–1432.
5. Jonklaas J., Razvi S. (2019) Reference intervals in the diagnosis of thyroid dysfunction: treating patients not numbers. Lancet Diabetes Endocrinol. pii: S2213-8587(18)30371-1.
6. Wu Q., Rayman M.P., Lv H., et al. (2015) Low population selenium status is associated with increased prevalence of thyroid disease. JCEM, vol. 100, pp. 4037–4047.
7. Chaker L., Bianco A.C., Jonklaas J., Peeters R.P. (2017) Hypothyroidism. Lancet, vol. 390, pp. 1550–1562.
8. Rajput R., Chatterjee S., Rajput M. (2011) Can levothyroxine be taken as evening dose? Comparative evaluation of morning versus evening dose of levothyroxine in treatment of hypothyroidism. J. Thyroid Res.
9. Canaris G.J., Manowitz N.R., Mayor G., Ridgway E.C. (2000) The Colorado thyroid disease prevalence study. Arch Intern Med., vol. 160 (4), pp. 526–534.
10. Reed H.L. (1995) Circannual changes in thyroid hormone physiology: the role of cold environmental temperatures. Arctic Med Res., vol. 54, Suppl 2, pp. 9–15.
11. Gullo D., Latina A., Frasca F. et al. (2017) Seasonal variations in TSH serum levels in athyreotic patients under L-thyroxine replacement monotherapy. Clin Endocrinol (Oxf)., vol. 87(2), pp. 207–215.
12. Wiersinga W.M., Duntas L., Fadeyev V., Nygaard B., Vanderpump M.P. (2012) 2012 ETA Guidelines: The Use of L-T4 + L-T3 in the Treatment of Hypothyroidism. Eur Thyroid J., vol. 1(2), pp. 55–71.
13. Samuels M.H., Schuff K.G., Carlson N.E., Carello P., Janowsky J.S. (2007) Health status, psychological symptoms, mood, and cognition in L-thyroxine treated hypothyroid subjects. Thyroid, vol. 17, pp. 249–258.
14. Taylor P.N., Panicker V., Sayers A., Shields B. et al. (2011) A meta-analysis of the associations between common variation in the PDE8B gene and thyroid hormone parameters, including assessment of longitudinal stability of associations over time and effect of thyroid hormone replacement. Eur J. Endocrinol., vol. 164(5), pp. 773–780.
15. Siegmund W., Spieker K., Weike A.I., Giessmann T. et al. (2004) Replacement therapy with levothyroxine plus triiodothyronine (bioavailable molar ratio 14: 1) is not superior to thyroxine alone to improve well-being and cognitive performance in hypothyroidism. Clin Endocrinol (Oxf)., vol. 60(6), pp. 750–757.
16. Jonklaas J., Bianco A.C., Bauer A.J., Burman K.B. et al. (2014) Guidelines for the Treatment of Hypothyroidism: Prepared by the American Thyroid Association Task Force on Thyroid Hormone Replacement. Thyroid Vol., vol. 24 (12), pp. 1670–1750.
17. Koehler V.F., Reincke M., Spitzweg C. (2018) Hypothyroidism-when and how to treat? Internist (Berl), vol. 59 (7), pp. 644–653.
18. Ochs N., Auer R., Bauer D.C., Nanchen D. et al. (2008) Meta-analysis: Subclinical Thyroid Dysfunction and the Risk for Coronary Heart Disease and Mortality. Ann Intern Med., vol. 148(11), pp. 832–845.
19. Walsh J.P., Bremner A.P., Bulsara M.K., O’Leary P. et al. (2005) Subclinical thyroid dysfunction as a risk factor for cardiovascular disease. Arch Intern Med., vol. 165 (21), pp. 2467–2472.
20. Chen H.S., Wu T.E., Jap T.S., Lu R.A. et al. (2007) Subclinical hypothyroidism is a risk factor for nephropathy and cardiovascular diseases in Type 2 diabetic patients. Diabet Med., vol. 24 (12), pp. 1336–1344.
21. Gencer B., Rodondi N. (2016) Evidence and controversies regarding the screening for subclinical hypothyroidism in patients with cardiovascular disease. JTD, vol. 8 (6), pp. E 446–450.
22. Pearce S.H.S., Brabant G. J-L. Wemenau et al. (2014 ) ETA Guideline: Management of Subclinical Hypothyroidism. European Thyroid Journal, vol. 2 (4), pp. 215–228.
23. Jebasingh K.F., Naik D. (2018) Thomas N Subclinical hypothyroidism. Current Medical Issues; vol. 16 (2), pp. 39–41.
24. Rodondi N., den Elzen W.P., Bauer D.C., et al. (2010) Thyroid Studies Collaboration.Subclinical hypothyroidism and the risk of coronary heart disease and mortality. JAMA, vol. 304 (12), pp. 1365–1374.
25. Pearce S.H., Razvi S., Yadegarfar M.E., Martin-Ruiz C. et al. (2016) Serum Thyroid Function, Mortality and Disability in Advanced Old Age: The Newcastle 85+ Study. JCEM, vol. 101(11), pp. 4385–4394.
26. Stott D.J., Rodondi N., Kearney P.M., Ford I. et al. (2017) For the TRUST Study Group Thyroid Hormone Therapy for Older Adults with Subclinical Hypothyroidism. NEJM, vol. 376, pp. 2534–2544.
27. Pearce S.H.S., Brabant G. J-L. Wemenau et al. (2013) ETA Guideline: Management of Subclinical Hypothyroidism. European Thyroid Journal, vol. 2 (4), pp. 215–228.
28. Fadeev V.V. (2010) Zamestitel’naya terapiya gipotireoza: nereshennie problemi ili predrassudki proshlogo (klinicheskoe esse) [Hypothyroidism replacement therapy: unresolved problems or prejudices of the past (clinical essay)]. Klinicheskaya i eksperimental’naya tireoidologiya [Clinical and experimental thyroidology], vol. 6, no 2, pp. 3–10.
29. Alexander E.K., Pearce E.N., Brent G.A., Brown R.S., et al. (2017) Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and the Postpartum. Thyroid, vol. 27 (3), pp. 315–389. https://doi.org/10.1089/thy.2016.0457
30. Chaker L., Bianco A.C., Jonklaas J., Peeters R.P. (2017) Hypothyroidism. Lancet, vol. 390, pp. 1550–1562.
31. Persani L., Brabant G., Dattani M. et al. (2018) European Thyroid Association (ETA) Guidelines on the Diagnosis and Management of Central Hypothyroidism. Eur Thyroid J., vol. 7, pp. 225–237.
32. Wiersinga W.M. (2017) Therapy of endocrine disease: T4 + T3 combination therapy: is there a true effect? Eur J. Endocrinol., vol. 177(6), pp. R287–R296.
