Медицинская литература. Новинки

 

 

 

 

 

 

Лечение первичного гипотиреоза: нерешенные вопросы

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Первичный гипотиреоз является одним из наиболее распространенных эндокриннвж заболеваний. По современным представлениям, лечение манифестного гипотиреоза подразумевает назначение заместительной монотерапии левотироксином (L-T 4), что обеспечивает поддержание компенсации заболевания. Достижение компенсации в подавляющем большинстве случаев приводит к нормализации самочувствия больных, купированию симптомов гипотиреоза и, как следствие, повышению качества жизни. Однако, по данным разных авторов, у 5-10% пациентов с гипотиреозом, получающих L-T 4, сохраняются сниженное настроение, повышенные уровни тревожности и депрессии, несмотря на поддержание стойко нормального уровня ТТГ. В обзоре обсуждаются подходы к ведению таких пациентов и как один из вариантов - перевод на комбинированную терапию левотироксином и трийодтиронином (L-T 4+T 3).

Ключевые слова:
первичный гипотиреоз, заместительная терапия, аутоиммунный тиреоидит, болезнь Грейвса, левотироксин, трийодтиронин, hypothyroidism, replacement therapy, autoimmune thyroiditis, Graves''disease, levothyroxine, triiodothyronine

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Treatment of primary hypothyroidism: unresolved issues

Primary hypothyroidism is one of the most common endocrine disorders. According to modern concepts, replacement monotherapy with levothyroxine (L-T 4) is the treatment of choice in primary hypothyroidism. In most cases, compensation of hypothyroidism leads to relief of symptoms and, as a consequence, improvement the quality of life. However, according to different authors, 5-10% of patients with hypothyroidism receiving adequate replacement therapy with L-T 4 have persistent symptoms of hypothyroidism, increased levels of anxiety and depression. The review discusses approaches to managing of such patients, and as one of the options - transfer to combination therapy with levothyroxine and triiodothyronine (L-T 4+T 3).

Keywords:
первичный гипотиреоз, заместительная терапия, аутоиммунный тиреоидит, болезнь Грейвса, левотироксин, трийодтиронин, hypothyroidism, replacement therapy, autoimmune thyroiditis, Graves''disease, levothyroxine, triiodothyronine