The School of Medicine and Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK.
Department of Endocrinology and Diabetes, Salford Royal Hospital, Salford, UK.
Int J Clin Pract. 2021 Dec;75(12):e14967. doi: 10.1111/ijcp.14967. Epub 2021 Nov 20.
Some levothyroxine unresponsive individuals with hypothyroidism are prescribed a natural desiccated thyroid (NDT) preparation such as Armour Thyroid or ERFA Thyroid . These contain a mixture of levothyroxine and liothyronine in a fixed ratio. We evaluated the response to NDT in individuals at a single endocrine centre in terms of how the change from levothyroxine to NDT impacted on their lives in relation to quality of life (QOL) and thyroid symptoms.
The ThyPRO39 (thyroid symptomatology) and EQ-5D-5L-related QoL/EQ5D5L (generic QOL) questionnaires were administered to 31 consecutive patients who had been initiated on NDT, before initiating treatment/6 months later.
There were 28 women and 3 men. The dose range of NDT was 60-180 mg daily. Age range was 26-77 years with length of time since diagnosis with hypothyroidism ranging from 2 to 40 years. One person discontinued the NDT because of lack of response; two because of cardiac symptoms. EQ-5D-5L utility increased from a mean (SD) of 0.214 (0.338) at baseline, to 0.606 (0.248) after 6 months; corresponding to a difference of 0.392 (95% CI 0.241-0.542), t = 6.82, P < .001. EQ-VAS scores increased from 33.4 (17.2) to 71.1 (17.5), a difference of 37.7 (95% CI 25.2-50.2), t = -4.9, P < .001. ThyPRO scores showed consistent fall across all domains with the composite QoL-impact Score improving from 68.3 (95% CI 60.9-75.7) to 25.2 (95% CI 18.7-31.7), a difference of 43.1 (95% CI 33-53.2) (t = 5.6, P < .001).
Significant symptomatic benefit and improvement in QOL was experienced by people with a history of levothyroxine unresponsive hypothyroidism treated with NDT, suggesting the need for further evaluation of NDT in this context.
一些甲状腺功能减退症患者对左甲状腺素治疗无反应，会被开处方使用天然甲状腺素（NDT）制剂，如 Armour Thyroid 或 ERFA Thyroid。这些制剂含有固定比例的左甲状腺素和三碘甲状腺原氨酸。我们在一家内分泌中心评估了 NDT 在个体中的反应，根据从左甲状腺素转为 NDT 对生活质量（QOL）和甲状腺症状的影响来衡量。
对 31 例连续接受 NDT 治疗的患者在开始治疗前（治疗前）和 6 个月后（治疗后）进行 ThyPRO39（甲状腺症状）和 EQ-5D-5L 相关 QoL/EQ5D5L（通用 QOL）问卷评估。
患者中有 28 名女性和 3 名男性，NDT 的剂量范围为 60-180mg/天。年龄范围为 26-77 岁，从诊断为甲状腺功能减退症到接受治疗的时间为 2-40 年。1 人因无反应而停止使用 NDT，2 人因心脏症状而停止使用 NDT。EQ-5D-5L 效用从基线时的平均（SD）0.214（0.338）增加到 6 个月后的 0.606（0.248）；差值为 0.392（95%CI 0.241-0.542），t 值为 6.82，P<.001。EQ-VAS 评分从 33.4（17.2）增加到 71.1（17.5），差值为 37.7（95%CI 25.2-50.2），t 值为-4.9，P<.001。ThyPRO 评分显示所有领域的一致性下降，复合 QoL 影响评分从 68.3（95%CI 60.9-75.7）改善至 25.2（95%CI 18.7-31.7），差值为 43.1（95%CI 33-53.2）（t 值为 5.6，P<.001）。
在接受 NDT 治疗的既往左甲状腺素无反应性甲状腺功能减退症患者中，观察到有显著的症状改善和生活质量提高，提示需要进一步评估 NDT 在这种情况下的应用。
