Rajput Rajesh, Pathak Vaibhav
Department of Endocrinology and Medicine Unit V, Pt. B.D. Sharma Postgraduate Institute of Medical Sciences, Rohtak, India.
Eur Thyroid J. 2017 Sep;6(5):250-254. doi: 10.1159/000477348. Epub 2017 Aug 3.
We compare the effect of daily versus weekly levothyroxine (LT4) replacement on thyroid function test (TFT) in hypothyroid patients at a tertiary care centre in Haryana.
This was a randomised crossover study in which 100 hypothyroid patients on a stable LT4 dose were divided into 2 groups of 50 each. In group I, patients were given daily therapy for 6 weeks and then shifted to weekly therapy for the next 6 weeks. In group II, patients were given LT4 once a week for 6 weeks and then switched to daily therapy for the next 6 weeks. TFT, quality of life (QOL), and hyperthyroidism symptom scale (HSS) score of patients were compared in each group at 0, 6, and 12 weeks.
TFT remained within the normal range, but TSH increased (group I, daily 2.8 ± 1.4 mIU/L, weekly 3.9 ± 1.1 mIU/L, = 0.001; group II, weekly 4.6 ± 1.1 mIU/L, daily 2.7 ± 1.2 mIU/L, = <0.001) and T3/T4 decreased with weekly therapy as compared to daily therapy. No significant difference in HSS score was found between daily and weekly administration of LT4. With weekly therapy, QOL showed improvement in bodily pain, vitality, mental health, and social functioning.
Once-weekly LT4 administration is a reasonable alternative for patients, especially for those who have issues with compliance.
在哈里亚纳邦一家三级医疗中心，我们比较了每日与每周服用左甲状腺素（LT4）替代治疗对甲状腺功能减退患者甲状腺功能测试（TFT）的影响。
这是一项随机交叉研究，100名服用稳定剂量LT4的甲状腺功能减退患者被分为两组，每组50人。在第一组中，患者接受为期6周的每日治疗，然后在接下来的6周转为每周治疗。在第二组中，患者每周服用一次LT4，为期6周，然后在接下来的6周转为每日治疗。在第0、6和12周时比较每组患者的TFT、生活质量（QOL）和甲亢症状量表（HSS）评分。
TFT保持在正常范围内，但促甲状腺激素（TSH）升高（第一组，每日2.8±1.4 mIU/L，每周3.9±1.1 mIU/L，P = 0.001；第二组，每周4.6±1.1 mIU/L，每日2.7±1.2 mIU/L，P =<0.001），与每日治疗相比，每周治疗时三碘甲状腺原氨酸（T3）/甲状腺素（T4）降低。每日和每周服用LT4的HSS评分之间未发现显著差异。每周治疗时，QOL在身体疼痛、活力、心理健康和社会功能方面有所改善。
对于患者，尤其是那些有依从性问题的患者，每周一次服用LT4是一种合理的替代方案。
