Mikhail George S, Alshammari Sameer M, Alenezi Mohammed Y, Mansour Maged, Khalil Nesreen A
Endocrinology Unit, Jahra Hospital, Ministry of Health, Alsalmyia, Kuwait, Kuwait.
Endocr Pract. 2008 Jul-Aug;14(5):570-5. doi: 10.4158/EP.14.5.570.
To evaluate the effects of physiologic doses of levothyroxine replacement on the lipoprotein profile in patients with subclinical hypothyroidism (SCH).
In a prospective, double-blind, placebo-controlled study, we enrolled 120 patients--mostly, but not exclusively, premenopausal women--with SCH. Patients were randomly assigned to either a levothyroxine-treated group (n = 60) or a placebo (control) group (n = 60). Total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglycerides (TG) were measured before and 52 weeks after assignment to either group.
In the levothyroxine-treated group, the lipoprotein mean values before and after the 52-week study were as follows: TC, 5.05 +/- 0.98 mmol/L versus 4.74 +/- 0.87 mmol/L (P<.0001); LDL-C, 3.30 +/- 0.90 mmol/L versus 2.89 +/- 0.59 mmol/L (P<.01); TG, 1.18 +/- 0.71 mmol/L versus 0.95 +/- 0.53 mmol/L (P<.002); and HDL-C, 1.20 +/- 0.33 mmol/L versus 1.19 +/- 0.32 mmol/L (P = .29). In the control group, TC, HDL-C, and TG values remained unchanged after 52 weeks in comparison with baseline, but LDL-C mean values increased from 2.79 +/- 0.60 mmol/L to 3.11 +/- 0.77 mmol/L, a change that was statistically significant (P<.001). At the end of the study, the lipid profile changes between levothyroxine-treated and control groups were compared. Total cholesterol and LDL-C were significantly lower in the levothyroxine-receiving group (P<.029 and P<.0001, respectively) in comparison with the control group. The difference did not reach statistical significance for TG and HDL-C values.
In premenopausal women, SCH has a negative effect on the lipoprotein profile and may translate into a sizable cardiovascular risk if left untreated.
评估生理剂量左甲状腺素替代治疗对亚临床甲状腺功能减退症（SCH）患者脂蛋白谱的影响。
在一项前瞻性、双盲、安慰剂对照研究中，我们纳入了120例SCH患者，其中大多数（但并非全部）为绝经前女性。患者被随机分为左甲状腺素治疗组（n = 60）或安慰剂（对照）组（n = 60）。在分组前及分组后52周测量总胆固醇（TC）、低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）和甘油三酯（TG）。
在左甲状腺素治疗组中，52周研究前后脂蛋白平均值如下：TC，5.05±0.98 mmol/L对4.74±0.87 mmol/L（P<0.0001）；LDL-C，3.30±0.90 mmol/L对2.89±0.59 mmol/L（P<0.01）；TG，1.18±0.71 mmol/L对0.95±0.53 mmol/L（P<0.002）；HDL-C，1.20±0.33 mmol/L对1.19±0.32 mmol/L（P = 0.29）。在对照组中，52周后TC、HDL-C和TG值与基线相比保持不变，但LDL-C平均值从2.79±0.60 mmol/L增加到3.11±0.77 mmol/L，这一变化具有统计学意义（P<0.001）。在研究结束时，比较了左甲状腺素治疗组和对照组之间的血脂谱变化。与对照组相比，接受左甲状腺素治疗组的总胆固醇和LDL-C显著降低（分别为P<0.029和P<0.0001）。TG和HDL-C值的差异未达到统计学意义。
在绝经前女性中，SCH对脂蛋白谱有负面影响，若不治疗可能转化为相当大的心血管风险。
