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[甲状腺功能减退症和甲状腺功能亢进症的管理]

[Management of hypothyroidism and hyperthyroidism].

作者信息

Jiskra Jan

出版信息

Vnitr Lek. 2015 Oct;61(10):868-72.

Abstract

Functional thyropathies present significant health risks for patients. Advanced functional thyropathies are always treated while indications for therapy of subclinical thyropathies are individual and often controversial. It is widely agreed that these disorders should be diagnosed and individuals should be followed. The drug of choice in substitution therapy of hypothyroidism is levothyroxine, in the treatment of hyperthyroidism it is methimazole. Administration of propylthiouracil should be limited to the first trimester of pregnancy, because its serious hepatotoxicity has been described. Hyperthyroidism based on thyroid nodules and immunogenic hyperthyroidism not reaching long-term remission, need to be treated radically: by surgery or radioiodine treatment. When radiation protection requirements are met, radioiodine can also be administered on an outpatient basis. Exceptionally, small doses of methimazole can be administered over an extended period of time in individual cases.

摘要

功能性甲状腺疾病给患者带来重大健康风险。晚期功能性甲状腺疾病总是需要治疗,而亚临床甲状腺疾病的治疗指征因人而异且常常存在争议。人们普遍认为应诊断这些疾病并对个体进行随访。甲状腺功能减退替代治疗的首选药物是左甲状腺素,甲状腺功能亢进治疗的首选药物是甲巯咪唑。丙硫氧嘧啶的使用应限于妊娠的前三个月,因为已经描述了其严重的肝毒性。基于甲状腺结节的甲状腺功能亢进和未达到长期缓解的免疫性甲状腺功能亢进需要进行根治性治疗:通过手术或放射性碘治疗。当满足辐射防护要求时,放射性碘也可在门诊给药。在个别情况下,极少数情况下可长期给予小剂量甲巯咪唑。

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