Kucharska Anna Małgorzata, Witkowska-Sędek Ewelina, Rumińska Małgorzata, Pyrżak Beata
Department of Paediatrics and Endocrinology, Medical University of Warsaw, 02-091 Warsaw, Poland.
J Clin Med. 2021 Nov 17;10(22):5354. doi: 10.3390/jcm10225354.
The alterations in thyroid function during recombinant human growth hormone (rhGH) treatment have been reported by many authors since this therapy became widely available for patients with growth hormone deficiency (GHD). Decrease of thyroxine level is the most frequent observation in patients treated with rhGH. This paper presents literature data describing changes in thyroid function related to rhGH therapy and a current explanation of mechanisms involved in this phenomenon. The effect of GH on the hypothalamic-pituitary-thyroid (HPT) axis is dependent on a multilevel regulation beginning from influence on the central axis, thyroid, and extra-thyroidal deiodinases activity as well as the impact on thyroid hormone receptors on the end. Changes in central and peripheral regulation could overlap during rhGH therapy, resulting in central hypothyroidism or an isolated slight deficiency of thyroxine. The regular monitoring of thyroid function is recommended in patients treated with rhGH and the decision of levothyroxine (L-thyroxine) supplementation should be made in the clinical context, taking into account thyroid hormone levels, as well as the chance for satisfactory growth improvement.
自从重组人生长激素（rhGH）疗法广泛应用于生长激素缺乏症（GHD）患者以来，许多作者都报道了rhGH治疗期间甲状腺功能的改变。甲状腺素水平降低是接受rhGH治疗患者中最常见的观察结果。本文介绍了描述与rhGH治疗相关的甲状腺功能变化的文献数据，以及对这一现象所涉及机制的当前解释。生长激素对下丘脑-垂体-甲状腺（HPT）轴的作用取决于多级调节，从对中枢轴、甲状腺和甲状腺外脱碘酶活性的影响开始，最终对甲状腺激素受体产生影响。在rhGH治疗期间，中枢和外周调节的变化可能会重叠，导致中枢性甲状腺功能减退或单纯性轻度甲状腺素缺乏。建议对接受rhGH治疗的患者定期监测甲状腺功能，补充左甲状腺素（L-甲状腺素）的决定应在临床背景下做出，同时考虑甲状腺激素水平以及实现满意生长改善的可能性。
