Subclinical hyperthyroidism: possible danger of overzealous thyroxine replacement therapy.
Subclinical hyperthyroidism: possible danger of overzealous thyroxine replacement therapy.
复制标题
亚临床甲状腺功能亢进症：过度的甲状腺素替代治疗可能存在危险。
DOI：
10.1016/s0025-6196(12)65409-3
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发表时间：
1988
影响因子：
8.9
通讯作者：
Ross,DS
中科院分区：
文献类型：
--
作者：
Ross,DS
许多服用常规剂量左旋甲状腺素的患者血清甲状腺素（T4）轻微升高，血清三碘甲状腺原氨酸明显正常，血清促甲状腺激素（促甲状腺激素; TSH）浓度受到抑制，并且没有甲状腺功能亢进的临床症状。最近的报告表明，这些患者可能有亚临床甲状腺功能亢进症的不良反应，包括异常短的收缩时间间隔，肝酶升高，骨密度降低。关于使用哪种甲状腺功能测试来监测服用左旋甲状腺素的患者存在争议。对现有数据的回顾表明，甲状腺功能减退症患者使用左旋甲状腺素的替代剂量应进行调整，以便通过新的敏感测定法测量的血清TSH在正常范围内。需要抑制剂量左旋甲状腺素以缩小甲状腺肿组织或防止异常组织生长的患者应给予达到预期临床或生化反应所需的最小剂量。
Many patients taking customary doses of levothyroxine have slightly elevated serum thyroxine (T4), apparently normal serum triiodothyronine, suppressed serum thyrotropin (thyroid-stimulating hormone; TSH) concentrations, and no clinical symptoms of hyperthyroidism. Recent reports suggest that these patients may have adverse effects from subclinical hyperthyroidism, including abnormally short systolic time intervals, elevations in liver enzymes, and reductions in bone density. Controversy exists about which thyroid function tests should be used to monitor patients taking levothyroxine. A review of currently available data suggests that replacement doses of levothyroxine given to hypothyroid patients should be adjusted so that serum TSH measured by the new sensitive assays is within the normal range. Patients requiring suppressive doses of levothyroxine to shrink goitrous thyroid tissue or to prevent growth of abnormal tissue should be given the minimal dose needed to accomplish the desired clinical or biochemical response.