在Levothyroxine治疗患者中的甲状腺激素恒温:ELSA-巴西的发现
Gustavo C Penna1,2, Isabela M Bensenor3, Antonio C Bianco1
1Section of Adult and Pediatric Endocrinology, Diabetes & Metabolism, The University of Chicago, Chicago, IL 60637, USA.
The Journal of clinical endocrinology and metabolism
|March 20, 2024
概括
甲状腺功能低下症的Levothyroxine (LT4) 治疗可能无法完全恢复甲状腺激素 (TH) 稳定. 许多患者表现出异常的自由T4和自由T3水平,尽管TSH正常,挑战治疗的有效性.
科学领域:
- 内分泌学 在内分泌学.
- 代谢健康 代谢健康
- 临床研究 临床研究
背景情况:
- 在恢复甲状腺激素 (TH) 稳定性方面,勒沃西 (LT4) 的有效性受到争议.
- 甲状腺激素水平,包括甲状腺素 (T4) 和三甲状腺素 (T3),对于代谢调节至关重要.
- 了解治疗个体的TH稳态对于优化患者的治疗结果至关重要.
研究的目的:
- 评估使用levothyroxine (LT4) 治疗的个体的甲状腺激素 (TH) 稳定性.
- 分析TH水平使用来自巴西成年人健康长度研究 (ELSA-巴西) 的数据.
- 评估LT4治疗对血清TSH,FT4和FT3水平的影响.
主要方法:
- 在ELSA-巴西研究 (2008-2019) 中分析了来自15,105名巴西成年人的数据.
- 包括186名开始LT4治疗的参与者和243名持续LT4治疗的参与者.
- 在三个观察点评估血清铁热素 (TSH),自由T4 (FT4) 和自由T3 (FT3) 水平.
主要成果:
- 启动LT4降低了TSH的11-19%,增加了FT4的19%,并减少了FT3的7%.
- 大约40%的LT4治疗患者在FT3水平下降>10%.
- 许多患者表现出FT4水平高于或FT3水平低于正常参考范围,尽管TSH水平.
结论:
- 在所有甲状腺功能低下症患者中,Levothyroxine (LT4) 治疗不能保证甲状腺激素 (TH) 完全稳定.
- 在接受LT4治疗的患者中,很大一部分人表现出异常的FT4和FT3水平,即使在正常的TSH中也是如此.
- 需要进一步的研究,以了解这些持续的荷尔蒙失衡的临床影响.
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