Субклинический гипотиреоз: лечить или наблюдать?

Автор: Цанава И.А., Булгакова С.В., Меликова А.В.

Журнал: Вестник медицинского института "РЕАВИЗ": реабилитация, врач и здоровье @vestnik-reaviz

Статья в выпуске: 6 (48), 2020 года.

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Манифестный гипотиреоз встречается более чем у 5 % населения, а распространенность субклинического гипотиреоза достигает 15 %. В практике эндокринолога в большинстве случаев диагностика и лечение манифестного гипотиреоза не вызывает вопросов, тогда как субклинические изменения гормонов щитовидной железы довольно часто порождают множество дискуссий. Общепринятый референсный диапазон для ТТГ до 4,50 мкМЕ/мл противоречит данным, демонстрирующим, что более 95 % здоровых людей с эутиреозом имеют уровень ТТГ в сыворотке до 2,5 мкМЕ/мл. При этом накоплено множество данных о влиянии даже незначительно измененных уровней тиреоидных гормонов и ТТГ на различные ткани, органы и системы организма, в особенности на сердечно-сосудистую, нервную и репродуктивные системы. В данной обзорной статье проанализированы результаты работ, направленных на изучение взаимосвязи субклинического гипотиреоза с кардиоваскулярными и метаболическими нарушениями, когнитивными расстройствами, патологией беременных.

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Гипотиреоз, субклинический гипотиреоз, тиреоидные гормоны, тиреотропный гормон, левотироксин

Короткий адрес: https://sciup.org/143176784

IDR: 143176784 | DOI: 10.20340/vmi-rvz.2020.6.12

Список литературы Субклинический гипотиреоз: лечить или наблюдать?

Pirahanchi Y, Toro F, Jialal I. Physiology, Thyroid Stimulating Hormone (TSH) [Updated 2020 Jun 28]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan. Available at: https://www.ncbi.nlm.nih.gov/books/NBK499850/
Delitala AP, Capobianco G, Cherchi PL, Dessole S, Delitala G. Thyroid function and thyroid disorders during pregnancy: a review and care pathway. Arch Gynecol Obstet. 2019; 299(2): 327-338. https://doi.org/10.1007/s00404-018-5018-8
Garmendia Madariaga A, Santos Palacios S, Guillen-Grima F, Galofre JC. The incidence and prevalence of thyroid dysfunction in Europe: a meta-analysis. J Clin Endocrinol Metab. 2014;99:923-931. https://doi.org/10.1210/jc.2013-2409
Baumgartner C, Blum MR, Rodondi N. Subclinical hypothyroidism: Summary of evidence in 2014. Swiss Med Wkly. 2014;144:w14058. https://doi.org/10.4414/smw.2014.14058
Shestakova TP. Subclinical hypothyroidism is a modern view of the problem. RMJ. 2016;1:6-8. (In Russ.).
Pearce SH, Brabant G, Duntas LH, Monzani F, Peeters RP, Razvi S, Wemeau JL. 2013 ETA guideline: Management of subclinical hypothyroidism. Eur Thyroid J. 2013;2:215-228. https://doi.org/10.1159/000356507
Esfandiari NH, Papaleontiou M. Biochemical Testing in Thyroid Disorders. Endocrinol Metab Clin North Am. 2017;46(3):631-648. https://doi.org/10.1016/j.ecl.2017.04.002
Surks M, Ortiz E, Daniels G, Sawin C, Col N, Cobin R. Subclinical thyroid disease: scientific review and guidelines for diagnosis and management. JAMA. 2004;291:228-238. https://doi.org/10.1001/jama.291.2.228
Hollowell JG, Staehling NW, Flanders WD, Hannon WH, Gunter EW, Spencer CA, Braverman LE. Serum TSH, T(4), and thyroid antibodies in the United States population (1988 to 1994): National Health and nutrition examination survey (NHANES III). J Clin Endocrinol Metab. 2002;87:489-499. https://doi.org/10.1210/jcem.87.2.8182
Vanderpump MP, Tunbridge WM, French JM, Appleton D, Bates D, Clark F, Grimley Evans F, Hasan DM, Rodgers H, Tunbridge F. The incidence of thyroid disorders in the community: a twenty-year follow-up of the Whickham survey. Clin Endocrinol. 1995;43:55-68. https://doi.org/10.1111/j.1365-2265.1995.tb01894.x
Somwaru L, Rariy C, Arnold A, Cappola A. The natural history of subclinical hypothyroidism in the elderly: the Cardiovascular Health Study. J Clin Endocrinol Metab. 2012;97:1962-1969. https://doi.org/10.1210/jc.2011-3047
Canaris G, Manowitz N, Mayor G, Ridgway E. The Colorado Thyroid Disease Prevalence Study. Arch Intern Med. 2000;160:526-534. . https://doi.org/10.1001/archinte.160A526
Jorde R, Waterloo K, Storhaug H, Nyrnes A, Sundsfjord J, Jenssen T. Neuropsychological function and symptoms in subjects with subclinical hypothyroidism and the effect of thyroxine treatment. J Clin Endocrinol Metab. 2006;91:145-153
Razvi S, Ingoe L, Keeka G, Oates C, Mcmillan C, Weaver J. The beneficial effect of L-thyroxine on cardiovascular risk factors, endothelial function, and quality of life in subclinical hypothyroidism: randomized, crossover trial. J Clin Endocrinol Metab. 2007;92:1715-1723. . https://doi.org/10.1210/jc.2006-1869
Kahaly GJ. Polyglandular autoimmune syndrome type II. Presse Med. 2012;41:e663-e670. https://doi.org/10.10167j.lpm.2012.09.011
Chang C, Yeh Y, Caffrey J, Shih S, Chuang L, Tu Y. Metabolic syndrome is associated with an increased of subclinical hypothyroidism - A Cohort Study. Sci Rep. 2017;7:6754. . https://doi.org/10.1038/s41598-017-07004-2
Kitahara C, Platz E, Ladenson P, Mondul A, Menke A, Berrington De Gonzalez A. Body fatness and markers of thyroid function among U.S. men and women. PLoS One. 2012;7(4):e34979. https://doi.org/10.1371/journal.pone.0034979
Chikunguwo S, Brethauer S, Nirujogi V, Pitt T, Udomsawaengsup S, Chand B. Influence of obesity and surgical weight loss on thyroid hormone levels. Surg Obes Relat Dis. 2007;3(6):631-635. https://doi.org/10.1016Zj.soard.2007.07.011
Volkova AR, Dora SV, Berkovich OA, Dygun OD, Volkova EV, Ostroukhova EN. Subclinical hypothyroidism is a new cardiovascular risk factor. Therapy. 2016;6:23-28. (In Russ.).
Budnevsky AV, Kravchenko AYa, Drobysheva ES, Fes'kova AA. Subclinical hypothyroidism as a cause of dyslipidaemia. Clinical Medicine. 2015;1:13-17. (In Russ.).
Bindels A, Westendorp R, Frolich M, Seidell J, Blokstra A, Smelt A. The prevalence of subclinical hypothyroidism at different total plasma cholesterol levels in middle aged men and women: a need for case-finding? Clin Endocrinol. 1999;50:217-220. https://doi.org/10.1046/j.1365-2265.1999.00638.x
Danese M, Ladenson P, Meinert C, Powe N. Clinical Review 115: Effect of thyroxine therapy on serum lipoproteins in patients with mild thyroid failure: a quantitative review of the literature. J Clin Endocrinol Metab. 2000;85:2993-3001. https://doi.org/10.1210/jcem.85.9.6841
Sun J, Yao L, Fang Y, et al. Relationship between Subclinical Thyroid Dysfunction and the Risk of Cardiovascular Outcomes: A Systematic Review and Meta-Analysis of Prospective Cohort Studies. Int J Endocrinol. 2017;2017:8130796. https://doi.org/10.1155/2017/8130796
Ochs N, Auer R, Bauer D, Nanchen D, Gussekloo J, Cornuz J. Meta-analysis: subclinical thyroid dysfunction and the risk for coronary heart disease and mortality. Ann Intern Med. 2008;148:832-845. https://doi.org/10.7326/0003-4819-148-11-200806030-00225
Ning Y, Cheng YJ, Liu LJ, et al. What is the association of hypothyroidism with risks of cardiovascular events and mortality? A meta-analysis of 55 cohort studies involving 1,898,314 participants. BMC Med. 2017;15(1):21. https://doi.org/10.1186/s12916-017-0777-9
Udovcic M, Pena RH, Patham B, Tabatabai L, Kansara A. Hypothyroidism and the Heart. Methodist Debakey Cardiovasc J. 2017;13(2):55-59. https://doi.org/10.14797/mdcj-13-2-55
Andersen M, Olsen A, Madsen J, Faber J, Torp-Pedersen C, Gislason G. Levothyroxine substitution in patients with subclinical hypothyroidism and the risk of myocardial infarction and mortality. PLoS One. 2015;10(6):e0129793 https://doi.org/10.1371/journal.pone.0129793
Reuters V, Teixeira P, Vigario P, Almeida C, Buescu A, Ferreira M. Functional capacity and muscular abnormalities in subclinical hypothyroidism. Am J Med Sci. 2009;338:259-263. https://doi.org/ 10.1097/MAJ.0b013e3181af7c7c
Mainenti M, Vigario P, Teixeira P, Maia M, Oliveira F, Vaisman M. Effect of levothyroxine replacement on exercise performance in subclinical hypothyroidism. J Endocrinol Invest. 2009;32:470-473. https://doi.org/10.1007/BF03346488
Lee J, Buzkova P, Fink H, Vu J, Carbone L, Chen Z. Subclinical thyroid dysfunction and incident hip fracture in older adults. Arch Intern Med. 2010;170:1876-1883. https://doi.org/10.1001/archinternmed.2010.424
Svare A, Nilsen T, Asvold B, Forsmo S, Schei B, Bjoro T, Langhammer A. Does thyroid function influence fracture risk? Prospective data from the Hunt2 study, Norway. Eur J Endocrinol. 2013;169:845-852. https://doi.org/ 10.1530/EJE-13-0546
Aghili R, Khamseh M, Malek M, Hadian A, Baradaran H, Najafi L. Changes of subtests of Wechsler Memory Scale and cognitive function in subjects with subclinical hypothyroidism following treatment with levothyrox-ine. Arch Med Sci. 2012;8:1096-1101. https://doi.org/10.5114/aoms.2012.32423
Parsaik A, Singh B, Roberts R, Pankratz S, Edwards K, Geda Y. Hypothyroidism and risk of mild cognitive impairment in elderly persons: a population-based study. JAMA Neurol. 2014;71:201-207. https://doi.org/10.1001/jamaneurol.2013.5402
Golbert L, de Cristo AP, Faccin CS, et al. Serum TSH levels as a predictor of malignancy in thyroid nodules: A prospective study. PLoS One. 2017 Nov 16;12(11):e0188123. https://doi.org/10.1371/journal.pone.0188123
Kim SS, Lee BJ, Lee JC, Song SH, Kim BH, Son SM, Kim IJ, Kim YK, Kang YH. Preoperative serum thyroid stimulating hormone levels in well-differentiated thyroid carcinoma is a predictive factor for lateral lymph node metastasis as well as extrathyroidal extension in Korean patients: a single-center experience. Endocrine. 2011;39:259-265. https://doi.org/10.1007/s12020-010-9430-5
Fiore E, Rago T, Provenzale M, Scutari M, Ugolini C, Basolo F. L-Thyroxine-treated patients with nodular goiter have lower serum TSH and lower frequency of papillary thyroid cancer: results of a cross-sectional study on 27 914 Patients. Endocr Relat Cancer. 2010;17:231-239. https://doi.org/10.1677/ERC-09-0251
Alexander EK., Pearce EN, Brent GA, Brown RS, Chen H, Dosiou C, Grobman WA, Laurberg P, Lazarus JH, Mandel SJ, Peeters RP, Sullivan S. 2017 guidelines of the american thyroid association for the diagnosis and management of thyroid disease during pregnancy and the postpartum. Thyroid. 2017;27:315-389. https://doi.org/10.1089/thy.2016.0457
Shishko ON, Mohort TV, Shishko EI, Mohort EG. Thyroid status derangement in pregnant women with sub-clinical hypothyroidism and disease management. Lechebnoe delo: nauchno-prakticheskiy zhurnal. 2017;4;55-61. (In Russ.).
Karakosta P, Alegakis D, Georgiou V, Roumeliotaki T, Fthenou E, Vassilaki M. Thyroid dysfunction and auto-antibodies in early pregnancy are associated with increased risk of gestational diabetes and adverse birth outcomes. J Clin Endocrinol Metab. 2012;97:4464-4472. https://doi.org/10.1210/jc.2012-2540
Toulis K, Stagnaro-Green A, Negro R. Maternal subclinical hypothyroidsm and gestational diabetes mellitus: a meta-analysis. EndocrPract. 2014;20:703-714. https://doi.org/10.4158/EP13440.RA
Wilson K, Casey B, Mclntire D, Halvorson L, Cunningham F. Subclinical thyroid disease and the incidence of hypertension in pregnancy. Obstet Gynecol. 2012;119:315-320. https://doi.org/10.1097/A0G.0b013e318240de6a
Benhadi N, Wiersinga W, Reitsma J, Vrijkotte T, Bonsel G. Higher maternal TSH levels in pregnancy are associated with increased risk for miscarriage, fetal or neonatal death. Eur J Endocrinol. 2009;160:985-991. https://doi.org/10.1530/EJE-08-0953
Negro R, Schwartz A, Gismondi R, Tinelli A, Mangieri T, Stagnaro-Green A. Increased pregnancy loss rate in thyroid antibody negative women with TSH Levels between 2.5 and 5.0 in the first trimester of pregnancy. J Clin Endocrinol Metab. 2010;95:E44-E48. https://doi.org/10.1210/jc.2010-0340
Demidova T.Ju., Balutina O.V., Gritzkevich E.Ju. News of clinical recommendations on diagnostics and treatment of subclinical hypothyroidism in pregnant women. Therapy. 2018;5(23):61-65. (In Russ.).
Thompson W, Russell G, Baragwanath G, Matthews J, Vaidya B, Thompson-Coon J. Maternal thyroid hormone insufficiency during pregnancy and risk of neurodevelopmental disorders in offspring: A systematic review and meta-analysis. Clin Endocrinol (Oxf). 2018;88(4):575-584. https://doi.org/10.1111/cen.13550

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