Antonelli Alessandro, Fallahi Poupak, Di Bari Flavia, Giuggioli Dilia, Ferrari Silvia Martina, Ferri Clodoveo
Department of Clinical and Experimental Medicine, University of Pisa, Italy.
Department of Clinical and Experimental Medicine, Section of Endocrinology, University of Messina, Italy.
Clin Exp Rheumatol. 2017 Sep-Oct;35 Suppl 106(4):193-197. Epub 2017 Apr 4.
Persistent fatigue (defined as ongoing exhaustion, disproportionate to exertion and not adequately alleviated by rest) reduces health-related quality of life of systemic sclerosis (SSc) patients. Fatigue in SSc is associated with reduced capacity to carry out daily activities, work disability and impaired physical function. Clinical studies demonstrated a high prevalence of autoimmune thyroiditis and hypothyroidism in patients with SSc. Since hypothyroidism and the associated fatigue symptoms could be cured by L-thyroxine (L-T4) substitutive therapy, the evolution of fatigue symptoms in SSc hypothyroid patients treated with substitutive therapy has been recently evaluated, showing an amelioration of the fatigue symptoms. We have treated 10 clinical hypothyroid and 23 subclinical hypothyroid female SSc patients (all with diffuse scleroderma) with L-T4 substitutive therapy. Mean baseline General Fatigue Index scores in hypothyroid SSc (15.7±5.1) were significantly higher (greater fatigue; p<0.01) than in the same patients after reaching euthyroidism at 4 months (9.6±3.1). The results suggest that female SSc patients could be screened for thyroid function, overall in presence of fatigue symptoms, and that an appropriate L-T4 substitutive therapy could be useful to mitigate these symptoms. Further studies are needed in larger samples of hypothyroid patients with SSc to confirm these data. Further longitudinal studies could be also aimed to evaluate if L-T4 therapy could be useful in alleviating complications of SSc (such as skin thickness, pulmonary hypertension, etc.).
持续性疲劳（定义为持续的疲惫感，与 exertion 不成比例且休息后无法充分缓解）会降低系统性硬化症（SSc）患者与健康相关的生活质量。SSc 患者的疲劳与日常活动能力下降、工作残疾和身体功能受损有关。临床研究表明，SSc 患者中自身免疫性甲状腺炎和甲状腺功能减退的患病率很高。由于甲状腺功能减退及相关疲劳症状可通过左甲状腺素（L-T4）替代疗法治愈，最近对接受替代疗法的 SSc 甲状腺功能减退患者疲劳症状的演变进行了评估，结果显示疲劳症状有所改善。我们用 L-T4 替代疗法治疗了 10 例临床甲状腺功能减退和 23 例亚临床甲状腺功能减退的女性 SSc 患者（均为弥漫性硬皮病）。甲状腺功能减退的 SSc 患者的平均基线一般疲劳指数评分（15.7±5.1）在 4 个月达到甲状腺功能正常后（9.6±3.1）显著更高（疲劳更严重；p<0.01）。结果表明，女性 SSc 患者可进行甲状腺功能筛查，尤其是在出现疲劳症状时，适当的 L-T4 替代疗法可能有助于减轻这些症状。需要对更大样本的 SSc 甲状腺功能减退患者进行进一步研究以证实这些数据。进一步的纵向研究还可旨在评估 L-T4 疗法是否有助于缓解 SSc 的并发症（如皮肤厚度、肺动脉高压等）。
