Division of Endocrinology, Georgetown University, Washington, DC 20007, USA.
Endocrinol Metab Clin North Am. 2022 Jun;51(2):243-263. doi: 10.1016/j.ecl.2021.12.003. Epub 2022 May 4.
Diverse causes potentially underlie decreased quality of life in biochemically euthyroid patients treated for hypothyroidism with levothyroxine. Once these contributing factors are addressed, if symptoms persist, there may be benefit to personalized use of combination therapy adding liothyronine. This approach should be carefully monitored: avoiding overtreatment and ensuring that therapy is only continued if it improves patient-reported quality of life. Most randomized clinical trials have not shown benefits, perhaps because of not targeting the most symptomatic patients. Sustained-release liothyronine preparations may soon be available for optimally designed studies assessing whether combination therapy provides superior therapy for hypothyroidism in select patients.
多种原因可能导致接受左甲状腺素治疗的甲状腺功能减退症患者的生活质量下降，尽管这些患者的甲状腺功能生化指标正常。如果这些因素得到解决，但症状仍然存在，那么使用左甲状腺素联合三碘甲状腺原氨酸的个体化治疗可能会有获益。这种方法应仔细监测：避免过度治疗，并确保仅在改善患者报告的生活质量的情况下继续治疗。大多数随机临床试验并未显示出获益，这可能是因为未针对症状最明显的患者进行治疗。不久将有控释型三碘甲状腺原氨酸制剂可供使用，以便进行设计更合理的研究，评估在某些患者中联合治疗是否为甲状腺功能减退症提供了更好的治疗选择。
