Pérez A, Cubero J M, Sucunza N, Ortega E, Arcelús R, Rodriguez-Espinosa J, Ordoñez-Llanos J, Blanco-Vaca F
Serveis d'Endocrinologia, Bioquímica i Institut de Recerca, Hospital Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, 08025 Barcelona, Spain.
Metabolism. 2004 Nov;53(11):1512-5. doi: 10.1016/j.metabol.2004.05.016.
Subclinical hypothyroidism (SH) is a frequent condition that may be associated with increased cardiovascular risk. There is current interest in determining the effect, if any, of substitutive therapy with l-thyroxine (L-T4) on cardiovascular risk factors in SH and, particularly, on those associated with emerging cardiovacular risk, such as apolipoprotein (apo) B, lipoprotein (Lp) (a), total homocysteine (t-Hcy), and C-reactive protein (CRP). Thus, the aim of this study was to assess the impact of euthyroidism restoration on these emerging risk factors in SH. Forty-two patients diagnosed with SH were consecutively recruited before treatment. These patients were treated with L-T4 for 3 to 6 months with the dose necessary to restore euthyroidism. Lp(a), fasting and postmethionine (n = 28) t-Hcy, and CRP did not change with substitutive therapy, regardless of the respective baseline values, and the decrease in apo B paralleled that of low-density lipoprotein (LDL) cholesterol. Similarly, no treatment effect was observed on homocysteine or CRP in patients with thyrotropin-stimulating hormone (TSH) >10 mIU/L. Monitoring of emerging risk factors did not offer additional arguments for treating patients with SH and, thus, is not justified in their clinical management.
亚临床甲状腺功能减退（SH）是一种常见病症，可能与心血管风险增加相关。目前人们关注左甲状腺素（L-T4）替代疗法对SH患者心血管危险因素的影响，尤其是对那些与新出现的心血管风险相关的因素，如载脂蛋白（apo）B、脂蛋白（Lp）（a）、总同型半胱氨酸（t-Hcy）和C反应蛋白（CRP）的影响。因此，本研究的目的是评估甲状腺功能正常化对SH患者这些新出现的危险因素的影响。42例确诊为SH的患者在治疗前被连续招募。这些患者接受L-T4治疗3至6个月，使用恢复甲状腺功能正常所需的剂量。无论各自的基线值如何，Lp（a）、空腹和蛋氨酸负荷后（n = 28）的t-Hcy以及CRP在替代治疗后均未改变，apo B的下降与低密度脂蛋白（LDL）胆固醇的下降平行。同样，促甲状腺激素（TSH）>10 mIU/L的患者在同型半胱氨酸或CRP方面未观察到治疗效果。监测新出现的危险因素并不能为治疗SH患者提供额外的依据，因此在其临床管理中没有必要。
