使用36点甲状腺症状问卷来潜在地指导最佳的甲状腺激素替代疗法
Thanh D Hoang1, Arjun A Patel1, Andrew J Spiro1
1Division of Endocrinology, Walter Reed National Military Medical Center, Bethesda, Maryland.
概括
接受levothyroxine (LT4) 治疗的中度至重度甲状腺功能低下症症状的患者可能从转换为组合疗法 (LT4+LT3) 或干燥甲状腺提取物 (DTE) 中受益. 那些在LT4上有轻微症状的人应该继续当前的治疗.
科学领域:
- 内分泌学 在内分泌学.
- 甲状腺学 甲状腺学
- 药理学 药理学是指药理学的学科.
背景情况:
- 利沃甲状腺素 (LT4) 是对甲状腺功能低下症的标准治疗方法.
- 一些患者经历了持续的症状,尽管在LT4治疗中甲状腺刺激激素 (TSH) 水平正常化.
- 这可能表明需要替代性或辅助性甲状腺激素配方.
研究的目的:
- 评估从LT4转换为组合疗法 (勒沃西 + 利奥西 [LT4+LT3]) 或干燥甲状腺提取物 (DTE) 对患者报告的症状的影响.
- 确定基线症状严重程度对LT4的影响是否影响治疗偏好和结果.
主要方法:
- 对来自两个随机,双盲,交叉研究的143名患者进行了后期小组分析.
- 患者被分为低,中等和高症状组,基于他们在LT4期间的甲状腺症状问卷 (TSQ-36) 评分.
- 症状评分 (TSQ-36) 在正常TSH水平的LT4,LT4+LT3和DTE治疗中进行了比较.
主要成果:
- 与LT4.4相比,在LT4中出现中度至严重症状的患者报告DTE的症状得分明显较低,在某些情况下,LT4+LT3比LT4.4更低.
- 与DTE和LT4+LT3.3相比,在LT4上症状较低的患者在LT4上症状得分较低.
- 治疗偏好与症状严重程度相关,那些更喜欢组合治疗的人具有更高的基线症状得分.
结论:
- 甲状腺症状问卷 (TSQ-36) 可以量化症状并指导甲状腺激素治疗选择.
- 患有LT4持续中度至重度症状的患者可能受益于组合疗法或DTE的试验.
- 在LT4上出现轻微症状的个体通常应该继续LT4单疗法.
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