Primary hypothyroidism and quality of life.
Primary hypothyroidism and quality of life.
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DOI：
10.1038/s41574-021-00625-8
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发表时间：
2022-04
期刊：
影响因子：
--
通讯作者：
Perros P
中科院分区：
文献类型：
--
作者：
Hegedüs L;Bianco AC;Jonklaas J;Pearce SH;Weetman AP;Perros P
在20世纪70年代，甲状腺提取物的治疗被左甲状腺素取代，左甲状腺素是一种合成形式的四碘甲状腺原氨酸。从那时起，甲状腺功能减退的治疗再无重大创新。亚临床甲状腺功能减退症的生化定义是一个有争议的问题。不加选择地筛查甲状腺功能减退导致过度诊断和治疗开始时血清促甲状腺激素（TSH）水平低于以前。甲状腺功能减退或甲状腺功能亢进对健康的不良影响已被证实，这些不良影响可影响健康相关的生活质量（QOL）。左旋甲状腺素替代改善，但并不总是正常化，生活质量，特别是对轻度甲状腺功能减退的个体。然而，无论是联合左甲状腺素和碘甲状腺原氨酸（三碘甲状腺原氨酸的合成形式）的研究，还是使用干燥甲状腺提取物，都没有显示出患者满意度的显著提高。未来的研究不仅应该集中在更好地了解个体的TSH设定点（个体在甲状腺功能减退症发病前血清TSH浓度的先天狭窄生理范围）和替代甲状腺激素组合和配方，而且还应该集中在与甲状腺功能减退症无关的自身免疫和合共病上，这些都是患者不满意的驱动因素。关注甲状腺功能减退症的长期健康后果，超越生活质量和过度治疗的风险是必要的。
In the 1970s, treatment with thyroid extract was superseded by levothyroxine, a synthetic l form of tetraiodothyronine. Since then, no major innovation has emerged for the treatment of hypothyroidism. The biochemical definition of subclinical hypothyroidism is a matter of debate. Indiscriminate screening for hypothyroidism has led to overdiagnosis and treatment initiation at lower serum levels of thyroid-stimulating hormone (TSH) than previously. Adverse health effects have been documented in individuals with hypothyroidism or hyperthyroidism, and these adverse effects can affect health-related quality of life (QOL). Levothyroxine substitution improves, but does not always normalize, QOL, especially for individuals with mild hypothyroidism. However, neither studies combining levothyroxine and liothyronine (the synthetic form of tri-iodothyronine) nor the use of desiccated thyroid extract have shown robust improvements in patient satisfaction. Future studies should focus not only on a better understanding of an individual’s TSH set point (the innate narrow physiological range of serum concentration of TSH in an individual, before the onset of hypothyroidism) and alternative thyroid hormone combinations and formulations, but also on autoimmunity and comorbidities unrelated to hypothyroidism as drivers of patient dissatisfaction. Attention to the long-term health consequences of hypothyroidism, beyond QOL, and the risks of overtreatment is imperative.
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影响因子：
6.6
作者：
Dumitrescu, Alexandra M.;Hanlon, Erin C.;Bianco, Antonio C.
通讯作者：
Bianco, Antonio C.
影响因子：
3.6
作者：
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通讯作者：
Welch JL
影响因子：
4.8
作者：
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通讯作者：
LARSEN, PR
DOI：
10.14310/horm.2002.1274
发表时间：
2010-07-01
影响因子：
3.2
作者：
Fadeyev, Valentine V.;Morgunova, Tatyana B.;Dedov, Ivan I.
通讯作者：
Dedov, Ivan I.
影响因子：
15.9
作者：
de Castro, Joao Pedro Werneck;Fonseca, Tatiana L.;Bianco, Antonio C.
通讯作者：
Bianco, Antonio C.