Leese Graham P, Soto-Pedre Enrique, Donnelly Louise A
Department of Endocrinology and Diabetes, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK.
Division of Cardiovascular & Diabetes Medicine, School Of Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK.
Clin Endocrinol (Oxf). 2016 Dec;85(6):918-925. doi: 10.1111/cen.13052. Epub 2016 Mar 21.
To look at adverse outcomes for patients on liothyronine compared to l-thyroxine. Some trials have examined the relative merits of liothyronine but none have looked at adverse outcomes in large numbers.
An observational study of all patients prescribed thyroid hormone replacement in Tayside Scotland (population 400 000) from 1997 to 2014.
A study group of patients having ever used liothyronine (n = 400) was compared to those who had only used l-thyroxine (n = 33 955). All patients were followed up until end-point, death or leaving Tayside.
Mortality rates and admissions with cardiovascular disease, atrial fibrillation, fractures, breast cancer and mental diseases were compared. Incident use of bisphosphonates, statins, antidepressants and antipsychotics was compared.
Compared to patients only taking l-thyroxine, those using liothyronine had no increased risk of cardiovascular disease [hazard ratio (HR) 1·04; 95% CI 0·70-1·54], atrial fibrillation (HR 0·91: 0·47-1·75), or fractures (HR 0·79: 0·49-1·27) after adjusting for age. There was no difference in the number of prescriptions for bisphosphonates or statins. There was an increased risk of new prescriptions for antipsychotic medication (HR 2·26: 1·64-3·11 P < 0·0001) which was proportional to the number of liothyronine prescriptions. There was a non-significant trend towards an increase in breast cancer and new use of antidepressant medications. During follow-up, median TSH was higher for patients on l-thyroxine alone (2·08 vs 1·07 mU/L; P < 0·001).
For patients taking long-term liothyronine we did not identify any additional risk of atrial fibrillation, cardiovascular disease or fractures. There was an increased incident use of antipsychotic medication during follow-up.
观察与左甲状腺素相比，服用碘塞罗宁的患者的不良结局。一些试验研究了碘塞罗宁的相对优点，但尚无研究观察大量患者的不良结局。
对1997年至2014年在苏格兰泰赛德地区（人口40万）接受甲状腺激素替代治疗的所有患者进行的一项观察性研究。
将曾使用过碘塞罗宁的一组患者（n = 400）与仅使用过左甲状腺素的患者（n = 33955）进行比较。所有患者均随访至终点，即死亡或离开泰赛德地区。
比较死亡率以及心血管疾病、心房颤动、骨折、乳腺癌和精神疾病的住院率。比较双膦酸盐类药物、他汀类药物、抗抑郁药和抗精神病药的使用情况。
与仅服用左甲状腺素的患者相比，服用碘塞罗宁的患者在调整年龄后，心血管疾病风险未增加[风险比（HR）1.04；95%置信区间0.70 - 1.54]，心房颤动风险未增加（HR 0.91：0.47 - 1.75），骨折风险未增加（HR 0.79：0.49 - 1.27）。双膦酸盐类药物或他汀类药物的处方数量无差异。抗精神病药物新处方的风险增加（HR 2.26：1.64 - 3.11，P < 0.0001），且与碘塞罗宁处方数量成正比。乳腺癌和抗抑郁药物新使用量有增加趋势，但无统计学意义。随访期间，仅服用左甲状腺素的患者促甲状腺激素中位数较高（2.08对1.07 mU/L；P < 0.001）。
对于长期服用碘塞罗宁的患者，我们未发现心房颤动、心血管疾病或骨折的任何额外风险。随访期间抗精神病药物的使用量有所增加。
