甲状腺功能减退症替代治疗并非简单问题

Replacement treatment of hypothyroidism:a complicated problem

甲状腺功能减退症是常见的内分泌疾病,一般不能治愈,需甲状腺激素终身替代治疗。无论原发性或中枢性甲状腺功能减退,左旋甲状腺素单药治疗是目前首选的治疗方法。原发性甲状腺功能减退主要依据血清促甲状腺激素水平,继发性甲状腺功能减退则需依据血清游离甲状腺素水平调整药物至适当剂量。甲状腺激素替代不足或过度治疗的问题在临床应用中仍然存在,尤其是过度替代治疗引起骨质疏松、增加心血管危险因素等不良反应,应尽量避免。此外,还需关注一些特殊情况下如儿童、老年患者及合并心血管或其他疾病患者的替代治疗。

Hypothyroidism is a common and permanent disorder in most patients, therefore requiring lifelong thyroid hormone replacement. Levothyroxine （ LT4 ） monotherapy remains the current standard strategy for management of primary as well as central hypothyroidism. Adequacy of treatment is monitored using serum thyrotropin in primary and serum FT4 in secondary hypothyroidism. Under- or over-treatment is common in clinical practice. Over-replacement is associated with increased risk of cardiovascular disease and osteoporosis, and hence should be avoided. Special considerations are needed in children, elderly patients and patients with cardiac disease or other diseases.