碘甲状腺原氨酸与左旋甲状腺素单药治疗的女性症状性甲状腺功能减退患者的甲状腺信号生物标志物:一项随机交叉试验

IF 1.7 Q4 ENDOCRINOLOGY & METABOLISM
Betty Ann Bjerkreim, S. S. Hammerstad, H. Gulseth, T. J. Berg, Sindre Lee-Ødegård, E. Eriksen
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引用次数: 0

摘要

促甲状腺激素(TSH)水平被认为可以反映甲状腺功能减退患者的疾病程度,使其水平正常化是治疗的目标。然而,尽管开始左旋甲状腺素(LT4)治疗后TSH水平足够,但5-10%的甲状腺功能减退患者抱怨症状持续存在,并对生活质量产生显著的负面影响。这表明TSH并不是所有患者细胞内甲状腺激素作用的最佳指标。我们的目的是研究LT3和LT4单药治疗对甲状腺信号通路其他生物标志物的不同影响,以及对残留甲状腺功能减退症状患者的不良反应。方法将59例经LT4单药或LT4/碘甲状腺原氨酸(LT3)联合治疗后仍有残留症状的女性甲状腺功能减退患者随机分组,分别接受LT4或LT3单药治疗,疗程为12周。测量,包括一些生化和激素参数的血清分析,在基线访问和两个治疗期后获得。结果LT4组游离甲状腺素(FT4)升高,LT3组游离三碘甲状腺原氨酸(FT3)升高。与LT4治疗相比,LT3治疗后逆转三碘甲状腺原氨酸(rT3)水平下降。与LT4治疗相比,LT3治疗后低密度脂蛋白(LDL)和总胆固醇水平均降低,而性激素结合球蛋白(SHBG)升高。两个治疗组的中位TSH水平均在参考范围内,但LT4组低于LT3组。我们没有发现两个治疗组在前b型利钠肽(NT前bnp)、握力、骨转换标志物或不良事件方面有任何差异。结论:我们已经证明,尽管TSH水平正常,但与LT3治疗相比,LT4治疗与LT3治疗相比,FT4、FT3、rT3、胆固醇和SHBG的值有显著差异。一般或骨骼特异性不良反应没有差异。该试验于2018年5月注册为NCT03627611。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Thyroid Signaling Biomarkers in Female Symptomatic Hypothyroid Patients on Liothyronine versus Levothyroxine Monotherapy: A Randomized Crossover Trial
Background Levels of thyroid-stimulating hormone (TSH) are believed to reflect degree of disease in patients with hypothyroidism, and normalization of levels is the treatment goal. However, despite adequate levels of TSH after starting levothyroxine (LT4) therapy, 5–10% of hypothyroid patients complain of persisting symptoms with a significant negative impact on quality of life. This indicates that TSH is not an optimal indicator of intracellular thyroid hormone effects in all patients. Our aim was to investigate different effects of LT3 and LT4 monotherapy on other biomarkers of the thyroid signaling pathway, in addition to adverse effects, in patients with residual hypothyroid symptoms. Methods Fifty-nine female hypothyroid patients, with residual symptoms on LT4 monotherapy or LT4/liothyronine (LT3) combination therapy, were randomly assigned in a non-blinded crossover study and received LT4 or LT3 monotherapy for 12 weeks each. Measurements, including serum analysis of a number of biochemical and hormonal parameters, were obtained at the baseline visit and after both treatment periods. Results Free thyroxine (FT4) was higher in the LT4 group, while free triiodothyronine (FT3) was higher in the LT3 group. The levels of reverse triiodothyronine (rT3) decreased after LT3 treatment compared with LT4 treatment. Both low-density lipoprotein (LDL) and total cholesterol levels were reduced, while sex hormone-binding globulin (SHBG) increased after LT3 treatment compared with LT4 treatment. The median TSH levels for both treatment groups were within the reference range, however, lower in the LT4 group than in the LT3 group. We did not find any differences in pro-B-type natriuretic peptide (NT pro-BNP), handgrip strength, bone turnover markers, or adverse events between the two treatment groups. Conclusion We have demonstrated that FT4, FT3, rT3, cholesterol, and SHBG show significantly different values on LT4 treatment compared with LT3 treatment in women with hypothyroidism and residual symptoms despite normal TSH levels. No differences in general or bone-specific adverse effects were demonstrated. This trial is registered with NCT03627611 in May 2018.
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来源期刊
Journal of Thyroid Research
Journal of Thyroid Research ENDOCRINOLOGY & METABOLISM-
CiteScore
4.40
自引率
0.00%
发文量
10
审稿时长
17 weeks
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