原发性甲状腺功能减退症患者左甲状腺素替代治疗前后疲劳的严重程度及其与促甲状腺激素的关系
Severity of Fatigue and Its Relationship with TSH before and after Levothyroxine Replacement Therapy in Patients with Primary Hypothyroidism.
作者信息
Ruíz-Pacheco María Guadalupe, Hernández Irma, Hernández-Estrella Guadalupe, Basurto Lourdes, Vargas-Ortega Guadalupe, González-Virla Baldomero, Molina-Ayala Mario, Hernández-Martínez Alex Francisco, Luengas-Mondragón Rosamaría, Hernández-Allende Angel Alejandro, Mendoza-Zubieta Victoria, Balcázar-Hernández Lourdes
机构信息
Centro Médico Nacional Siglo XXI, Department of Endocrinology, Hospital de Especialidades, Instituto Mexicano del Seguro Social, Mexico City 06720, Mexico.
Faculty of Medicine, Universidad Nacional Autónoma de México, Mexico City 04510, Mexico.
出版信息
Biomedicines. 2023 Mar 7;11(3):811. doi: 10.3390/biomedicines11030811.
BACKGROUND
Fatigue is a common symptom in hypothyroidism; however, the effect of levothyroxine on fatigue has been little studied. The aim of this study was to evaluate the effect of levothyroxine on fatigue in Latino patients with primary hypothyroidism, as well as the association of TSH and free T4 (FT4) with the severity and persistence of fatigue.
METHODS
A prospective study was performed in 92 patients with primary hypothyroidism. Fatigue severity scale (FSS) scores and clinical and biochemical characteristics before and at 6 months of levothyroxine were evaluated.
RESULTS
After 6 months of levothyroxine, a reduction in FSS (53 (47-57) vs. 36 (16-38); = 0.001) and fatigue frequency (45.7% vs. 26.1%; = 0.008) was evident. Both before and after 6 months of levothyroxine, there was a positive correlation of the FSS score with TSH and a negative correlation with FT4. Persistent fatigue was associated with a pretreatment FSS score (r = 0.75; = 0.001) and diabetes (r = 0.40; = 0.001). An FSS > 34 (RR 3.9 (95% CI 1.43-10.73; = 0.008)), an FSS > 36 (RR 3.23 (95% CI 1.21-8.6; = 0.019)), and diabetes (RR 5.7 (95% CI 1.25-9.6; = 0.024)) before treatment were risk factors for persistent fatigue.
CONCLUSIONS
Levothyroxine improved fatigue in most patients. Diabetes and an FSS score >34 or >36 before treatment were risk factors for persistent fatigue.
背景
疲劳是甲状腺功能减退症的常见症状；然而，左甲状腺素对疲劳的影响鲜少被研究。本研究的目的是评估左甲状腺素对拉丁裔原发性甲状腺功能减退症患者疲劳的影响，以及促甲状腺激素（TSH）和游离甲状腺素（FT4）与疲劳严重程度和持续性的关联。
方法
对92例原发性甲状腺功能减退症患者进行了一项前瞻性研究。评估了左甲状腺素治疗前及治疗6个月时的疲劳严重程度量表（FSS）评分以及临床和生化特征。
结果
左甲状腺素治疗6个月后，FSS评分明显降低（53（47 - 57）对36（16 - 38）；P = 0.001），疲劳频率也降低（45.7%对26.1%；P = 0.008）。在左甲状腺素治疗6个月前后，FSS评分均与TSH呈正相关，与FT4呈负相关。持续性疲劳与治疗前FSS评分（r = 0.75；P = 0.001）和糖尿病（r = 0.40；P = 0.001）相关。治疗前FSS > 34（相对危险度3.9（95%可信区间1.43 - 10.73；P = 0.008））、FSS > 36（相对危险度3.23（95%可信区间1.21 - 8.6；P = 0.019））以及糖尿病（相对危险度5.7（95%可信区间1.25 - 9.6；P = 0.024））是持续性疲劳的危险因素。
结论
左甲状腺素使大多数患者的疲劳症状得到改善。糖尿病以及治疗前FSS评分>34或>36是持续性疲劳的危险因素。
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