Department of Internal Medicine and Clinical Pharmacology, Medical University of Silesia, Medyków 18, PL 40-752 Katowice, Poland.
J Clin Endocrinol Metab. 2011 Jul;96(7):2206-15. doi: 10.1210/jc.2010-2986. Epub 2011 Apr 20.
No previous study determined monocyte- and lymphocyte-suppressing effects of levothyroxine and selenomethionine and assessed whether their coadministration is superior to treatment with only one of these drugs.
Our objective was to compare the effect of levothyroxine and selenomethionine on monocyte and lymphocyte cytokine release and systemic inflammation in patients with Hashimoto's thyroiditis.
DESIGN, SETTING, PARTICIPANTS, AND INTERVENTION: We conducted a randomized clinical trial involving a group of 170 ambulatory euthyroid women with recently diagnosed and previously untreated Hashimoto's thyroiditis and 41 matched healthy subjects. Participants were randomized in a double-blind fashion to receive a 6-month treatment with levothyroxine, selenomethionine, levothyroxine plus selenomethionine, or placebo. One hundred sixty-five patients completed the study.
Monocyte and lymphocyte release of proinflammatory cytokines and plasma levels of C-reactive protein (CRP) were assessed.
Compared with the control subjects, monocytes and lymphocytes of Hashimoto's thyroiditis patients released greater amounts of all cytokines studied. Levothyroxine reduced monocyte release of TNF-α, IL-1β, IL-6, and monocyte chemoattractant protein-1, whereas selenomethionine inhibited lymphocyte release of IL-2, interferon-γ, and TNF-α, which was accompanied by a reduction in plasma CRP levels. The decrease in cytokine release and in plasma CRP levels was strongest when both drugs were given together.
Despite affecting different types of inflammatory cells, levothyroxine and selenomethionine exhibit a similar systemic antiinflammatory effect in euthyroid females with Hashimoto's thyroiditis. This action, which correlates with a reduction in thyroid peroxidase antibody titers, may be associated with clinical benefits in the prevention and management of Hashimoto's thyroiditis, particularly in subjects receiving both agents.
此前尚无研究确定左甲状腺素和硒代蛋氨酸对单核细胞和淋巴细胞的抑制作用，并评估两者联合用药是否优于单一药物治疗。
我们旨在比较左甲状腺素和硒代蛋氨酸对桥本甲状腺炎患者单核细胞和淋巴细胞细胞因子释放及全身炎症的影响。
设计、地点、参与者和干预措施：我们开展了一项随机临床试验，纳入了 170 名患有新近诊断且未经治疗的桥本甲状腺炎的门诊甲状腺功能正常的女性和 41 名匹配的健康对照者。参与者以双盲的方式随机接受为期 6 个月的左甲状腺素、硒代蛋氨酸、左甲状腺素加硒代蛋氨酸或安慰剂治疗。165 名患者完成了该研究。
评估单核细胞和淋巴细胞促炎细胞因子的释放和 C 反应蛋白（CRP）的血浆水平。
与对照组相比，桥本甲状腺炎患者的单核细胞和淋巴细胞释放了更多的所有研究细胞因子。左甲状腺素降低了单核细胞释放 TNF-α、IL-1β、IL-6 和单核细胞趋化蛋白-1，而硒代蛋氨酸抑制了淋巴细胞释放 IL-2、干扰素-γ和 TNF-α，同时降低了 CRP 血浆水平。当两种药物同时使用时，细胞因子释放和 CRP 血浆水平的下降最为显著。
尽管作用于不同类型的炎性细胞，但左甲状腺素和硒代蛋氨酸在甲状腺功能正常的桥本甲状腺炎女性中表现出相似的全身抗炎作用。这种作用与甲状腺过氧化物酶抗体滴度的降低相关，可能与桥本甲状腺炎的预防和管理的临床获益相关，特别是在接受两种药物治疗的患者中。
