Jiskra Jan
Vnitr Lek. 2017 Fall;63(9):566-571.
Hypothyroidism is frequently found in patients with heart disease. It is a risk factor for atherosclerosis and ischemic heart disease and has a direct negative effect on both the left and right ventricular functions (hypothyroidism-induced cardiomyopathy). The confirmed manifest hypothyroidism is always a reason for replacement therapy with levothyroxine; regarding patients with heart disease, we always begin treatment with a small dose and increase it gradually. The treatment of subclinical hypothyroidism in patients with heart disease is disputable and its benefits probably depend on age. At a higher age, the therapy-related risks often outweigh its benefits, so we make do with the target levels of the thyroid stimulating hormone being within the upper band of the normal range, or even slightly above it, rather than overdosing the patient. To summarize in a simplified way, the treatment of subclinical hypothyroidism in patients with heart disease is the most effective in younger individuals, mainly those aged below 65, while at a higher age > 80 years the risk usually outweighs the benefit.Key words: cardiovascular risk - hypothyroidism - ischemic heart disease - left ventricular dysfunction - right ventricular dysfunction - subclinical hypothyroidism - thyroid peroxidase antibodies.
甲状腺功能减退症在心脏病患者中很常见。它是动脉粥样硬化和缺血性心脏病的危险因素，对左、右心室功能均有直接负面影响（甲状腺功能减退性心肌病）。确诊的显性甲状腺功能减退症始终是使用左甲状腺素替代治疗的原因；对于心脏病患者，我们总是从小剂量开始治疗并逐渐增加剂量。心脏病患者亚临床甲状腺功能减退症的治疗存在争议，其益处可能取决于年龄。在较高年龄时，治疗相关风险往往超过其益处，因此我们使促甲状腺激素的目标水平处于正常范围的上限内，甚至略高于该范围，而不是让患者过量用药。简而言之，心脏病患者亚临床甲状腺功能减退症的治疗在较年轻个体中最有效，主要是65岁以下的个体，而在80岁以上的较高年龄时，风险通常超过益处。关键词：心血管风险 - 甲状腺功能减退症 - 缺血性心脏病 - 左心室功能障碍 - 右心室功能障碍 - 亚临床甲状腺功能减退症 - 甲状腺过氧化物酶抗体
