Nath Mannmath, Gupta Balram, Rai Madhukar, Singh Surya K
Department of Endocrinology and Metabolism, Institute of Medical Sciences, Banaras Hindu University, Varanasi 221005, India.
Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi 221005, India.
Diabetes Metab Syndr. 2017 Dec;11 Suppl 2:S997-S1000. doi: 10.1016/j.dsx.2017.07.028. Epub 2017 Jul 20.
To study the loss of diurnal variation in blood pressure in normotensive patients with Subclinical/overt hypothyroidism and effect of Levothyroxine (L-T4) treatment.
In this interventional study Eighty patients between 17- 50 years with newly detected OH and SCH (74 women and 6 men) and nine euthyroid subjects (all men) with blood pressure <140/90 were recruited. All patients underwent 24h ambulatory blood pressure monitoring (ABPM) using ABPM machine before and after treatment with L-T4. Diurnal index (DI), Percent time elevation (PTE), Hyperbaric impact (HBI) were studied pre and post L-T4 treatment.
Of the 89 subjects (22 SCH, 58 OH and 9 controls), 7 of the SCH and 30 of OH subjects reported back in follow up after L-T4 supplementation for evaluation. DI, HBI and PTE when compared at baseline between different groups (SCH- OH, SCH- control, OH- control) were insignificant. After L-T4 supplementation DI, HBI and PTE varied significantly with p value 0.007, 0.003 and 0.003 respectively between SCH- OH only. Post L-T4 analysis in SCH group was statistically insignificant (p-value 0.102) but a trend toward improvement in DI was noted (baseline and post treatment DI mean 7.00 and 13.00 respectively).
Loss of nocturnal dipping was found in patients with OH and SCH which was restored after L-T4 therapy only in patients with SCH and not with OH.
of SCH patients with high cardiovascular risk may be beneficial in this setting and can be a new indication for LT4 therapy in SCH.
研究亚临床/显性甲状腺功能减退的血压正常患者的血压昼夜节律变化消失情况以及左甲状腺素（L-T4）治疗的效果。
在这项干预性研究中，招募了80例年龄在17至50岁之间新诊断出显性甲状腺功能减退（OH）和亚临床甲状腺功能减退（SCH）的患者（74名女性和6名男性）以及9名血压<140/90的甲状腺功能正常受试者（均为男性）。所有患者在L-T4治疗前后使用动态血压监测仪进行24小时动态血压监测（ABPM）。研究了L-T4治疗前后的昼夜指数（DI）、血压升高时间百分比（PTE）、高压影响（HBI）。
89名受试者（22名SCH、58名OH和9名对照）中，7名SCH受试者和30名OH受试者在补充L-T4后进行随访以评估。不同组（SCH-OH、SCH-对照、OH-对照）在基线时比较DI、HBI和PTE无显著差异。补充L-T4后，仅SCH-OH组的DI、HBI和PTE有显著变化，p值分别为0.007、0.003和0.003。SCH组L-T4治疗后分析无统计学意义（p值0.102），但注意到DI有改善趋势（基线和治疗后DI平均值分别为7.00和13.00）。
OH和SCH患者存在夜间血压下降消失的情况，L-T4治疗后仅SCH患者的这种情况得到恢复，OH患者未恢复。
在这种情况下，对具有高心血管风险的SCH患者进行治疗可能有益，这可能成为SCH患者L-T4治疗的新指征。
