Regalbuto Concetto, Maiorana Raffaella, Alagona Corradina, Paola Roberto Di, Cianci Michelangela, Alagona Giovanna, Sapienza Salvatore, Squatrito Sebastiano, Pezzino Vincenzo
Division of Endocrinology, Department of Internal and Specialistic Medicine, University of Catania, Italy.
Thyroid. 2007 Apr;17(4):323-31. doi: 10.1089/thy.2006.0084.
After total thyroidectomy all thyroid cancer patients require lifelong treatment with thyroid hormones; the treatment of choice is synthetic levothyroxine (LT4). The question of whether these patients might benefit from the combined LT4 and liothyronine (LT3) treatment has been addressed with conflicting conclusions. The aim of the present study was to compare the effects of combined low LT4/LT3 molar ratio therapy versus LT4 monotherapy on various target organs and tissues in patients thyroidectomized for thyroid cancer. Urine collection (24 hour), a fasting blood sample for laboratory examinations, thyroid function clinical score, and cardiovascular, neurological, and neuropsychological evaluations were obtained. Clinical parameters and peripheral markers of thyroid function were measured during the two different treatment regimens in 20 patients. Mean serum aspartate aminotransferase, alanine aminotransferase, sex hormone binding globulin, and osteocalcin values were significantly higher during the combined treatment. No significant differences in the clinical score, the systolic and diastolic performance, and the neurological and neuropsychological evaluations were observed between the two treatment regimens. Moreover, no alteration due to subclinical hyperthyroidism or to the fluctuations in serum T3 concentrations during the combined therapy was observed. In conclusion, we found no evidence that combined therapy with a low LT4/LT3 molar ratio resulted in improved well-being and cognitive function or in increased thyroid hormone action on peripheral tissues in respect to LT4 monotherapy. Until future large, blind, randomized, and controlled trials prove otherwise, LT4 should remain the standard treatment for thyroid cancer patients.
全甲状腺切除术后，所有甲状腺癌患者都需要终身接受甲状腺激素治疗；治疗的首选药物是合成左甲状腺素（LT4）。这些患者是否能从LT4和碘塞罗宁（LT3）联合治疗中获益这一问题已经得到探讨，但结论相互矛盾。本研究的目的是比较低LT4/LT3摩尔比联合治疗与LT4单药治疗对因甲状腺癌行甲状腺切除患者的各种靶器官和组织的影响。收集24小时尿液、采集空腹血样进行实验室检查、进行甲状腺功能临床评分以及进行心血管、神经和神经心理学评估。对20例患者在两种不同治疗方案期间测量临床参数和甲状腺功能的外周标志物。联合治疗期间，平均血清天冬氨酸转氨酶、丙氨酸转氨酶、性激素结合球蛋白和骨钙素值显著更高。两种治疗方案在临床评分、收缩和舒张功能以及神经和神经心理学评估方面未观察到显著差异。此外，联合治疗期间未观察到亚临床甲状腺功能亢进或血清T3浓度波动引起的改变。总之，我们没有发现证据表明低LT4/LT3摩尔比联合治疗相对于LT4单药治疗能改善患者的健康状况和认知功能，或增强甲状腺激素对周围组织的作用。在未来大规模、盲法、随机对照试验证明相反结论之前，LT4应仍然是甲状腺癌患者的标准治疗药物。
