甲状腺功能减退症中左甲状腺素治疗的代谢效应：左甲状腺素与左甲状腺素钠的随机、双盲、交叉试验。
Metabolic effects of liothyronine therapy in hypothyroidism: a randomized, double-blind, crossover trial of liothyronine versus levothyroxine.
机构信息
Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Building 10, CRC, Room 6-3940, 10 Center Drive, MSC 1613, Bethesda, Maryland 20892-1613, USA.
出版信息
J Clin Endocrinol Metab. 2011 Nov;96(11):3466-74. doi: 10.1210/jc.2011-1329. Epub 2011 Aug 24.
CONTEXT
Levothyroxine (L-T(4)) therapy is based on the assumption that the conversion of T(4) into T(3) provides adequate amounts of active hormone at target tissues. However, in rodents, L-T(4) alone does not restore a euthyroid state in all tissues. Previous combination L-T(4)/liothyronine (L-T(3)) therapy trials focused on quality-of-life endpoints, and limited information is available on the effects on other measures of thyroid hormone action.
OBJECTIVE
Our objective was to evaluate the efficacy of thyroid hormone replacement with L-T(4) or L-T(3) at doses producing equivalent normalization of TSH.
PARTICIPANTS, DESIGN, AND SETTING: Fourteen hypothyroid patients participated in this randomized, double-blind, crossover intervention at the National Institutes of Health Clinical Center.
INTERVENTIONS
L-T(3) or L-T(4) were administered thrice daily to achieve a target TSH from 0.5-1.5 mU/liter. Volunteers were studied as inpatients after 6 wk on a stable dose and at the target TSH.
MAIN OUTCOME MEASURES
Serum thyroid hormones, lipid parameters, and indices of glucose metabolism were evaluated.
RESULTS
No difference was observed in TSH between L-T(3) and L-T(4) treatments. L-T(3) resulted in significant weight loss [L-T(4), 70.6 ± 12.5, vs. L-T(3), 68.5 ± 11.9 kg (P = 0.009)] and in a 10.9 ± 10.0% decrease in total cholesterol (P = 0.002), 13.3 ± 12.1% decrease in low-density lipoprotein-cholesterol (P = 0.002), and an 18.3 ± 28.6% decrease in apolipoprotein B (P = 0.018). No significant differences were observed in high-density lipoprotein-cholesterol, heart rate, blood pressure, exercise tolerance, or insulin sensitivity.
CONCLUSIONS
The substitution of L-T(3) for L-T(4) at equivalent doses (relative to the pituitary) reduced body weight and resulted in greater thyroid hormone action on the lipid metabolism, without detected differences in cardiovascular function or insulin sensitivity.
背景
左甲状腺素（L-T4）治疗基于这样一种假设，即 T4 转化为 T3 可在靶组织中提供足够量的活性激素。然而，在啮齿动物中，单独使用 L-T4 并不能使所有组织恢复到甲状腺功能正常状态。以前的 L-T4/三碘甲状腺原氨酸（L-T3）联合治疗试验侧重于生活质量终点，而关于甲状腺激素作用的其他措施的信息有限。
目的
我们的目的是评估 L-T4 或 L-T3 替代甲状腺激素治疗，剂量使 TSH 正常化。
参与者、设计和环境：14 名甲状腺功能减退患者在国立卫生研究院临床中心参加了这项随机、双盲、交叉干预研究。
干预措施
L-T3 或 L-T4 每天三次给药，以达到 TSH 目标为 0.5-1.5 mU/L。志愿者在稳定剂量下住院治疗 6 周后，在 TSH 目标下进行研究。
主要观察指标
评估血清甲状腺激素、脂质参数和葡萄糖代谢指数。
结果
L-T3 和 L-T4 治疗之间 TSH 无差异。L-T3 导致显著的体重减轻[L-T4，70.6±12.5，vs. L-T3，68.5±11.9kg（P=0.009）]和总胆固醇降低 10.9±10.0%（P=0.002）、低密度脂蛋白胆固醇降低 13.3±12.1%（P=0.002）和载脂蛋白 B 降低 18.3±28.6%（P=0.018）。高密度脂蛋白胆固醇、心率、血压、运动耐量或胰岛素敏感性无显著差异。
结论
用 L-T3 替代 L-T4 等量替代（相对于垂体）可降低体重，并导致甲状腺激素对脂质代谢的作用更大，而未检测到心血管功能或胰岛素敏感性的差异。
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