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Вторичный гипотиреоз у взрослых: диагностика и лечение

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Вторичный гипотиреоз – редкая патология, при диагностике и лечении которой возникает ряд вопросов и трудностей. Выделяют казуистически редко встречающуюся врожденную и приобретенную формы данного заболевания. Основными причинами вторичного гипотиреоза у взрослых являются опухоли гипоталамо-гипофизарной области и состояния после оперативного и лучевого воздействия на эту область. Гормонально активные и неактивные макроаденомы гипофиза служат причиной развития приобретенного вторичного гипотиреоза более чем в 50% случаев. При лучевой терапии опухолей головного мозга развитие вторичного гипотиреоза возможно спустя годы после проведенного лечения. Как и при первичном гипотиреозе, клинические проявления вторичного гипотиреоза неспецифичны. Диагностика и лечение данного заболевания зачастую осложняются его сочетанием с недостаточностью других тропных гормонов. Основу диагностики вторичного гипотиреоза составляют анамнестические данные и лабораторные показатели – одновременное определение концентрации св.Т4 и ТТГ. Содержание св.Т4 на сегодняшний день также используют как основной маркер адекватности дозы L-Т4 при лечении вторичного гипотиреоза. Результаты недавно проведенных работ позволяют оптимизировать заместительную терапию при вторичном гипотиреозе, однако до настоящего времени остается неизученным вопрос использования дополнительных биохимических маркеров для оценки адекватности заместительной терапии.

Ключевые слова:
вторичный гипотиреоз, диагностика, левотироксин, заместительная терапия, оценка адекватности терапии, secondary hypothyroidism, diagnosis, levothyroxine, replacement therapy, assessment of the adequacy of therapy

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Secondary hypothyroidism in adults: diagnosis and treatment

Secondary hypothyroidism is a rare disease. There is a number of questions and difficulties in diagnosis and management of this condition. There are two forms of secondary hypothyroidism: congenital (casuistic seldom) and acquired. The main causes of secondary hypothyroidism in adults are tumors of the hypothalamic-pituitary region and the state after surgical and radiation effects on this area. Hormonally active and inactive pituitary macroadenomas cause the development of acquired secondary hypothyroidism in more than 50% of cases. The development of secondary hypothyroidism is possible years after the radiotherapy of brain tumors. As well as in case of primary hypothyroidism, the clinical manifestations of secondary hypothyroidism are non-specific. Diagnosis and management of this pathology is often complicated by its combination with the deficiency of other tropic hormones. The diagnosis of secondary hypothyroidism is based on anamnestic data and laboratory tests - the simultaneous determination of the levels of fT4 and TSH. The level of fT4 today is also used as the main marker of the adequacy of the dose of L-T4 in the treatment of secondary hypothyroidism. The results of recent studies help us to optimize replacement therapy in secondary hypothyroidism. However, the use of additional biochemical markers to assess the adequacy of replacement therapy remains unexplored.

Keywords:
вторичный гипотиреоз, диагностика, левотироксин, заместительная терапия, оценка адекватности терапии, secondary hypothyroidism, diagnosis, levothyroxine, replacement therapy, assessment of the adequacy of therapy