Department of Medical Endocrinology and Metabolism, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
Institute of Clinical Medicine, Faculty of Health and Clinical Sciences, Copenhagen University, Copenhagen, Denmark.
Endocrine. 2024 May;84(2):301-308. doi: 10.1007/s12020-023-03460-1. Epub 2023 Aug 9.
To provide an overview of consequences of undertreatment with levothyroxine (LT4) in the common non-communicable disease, hypothyroidism.
Narrative review of the literature.
Hypothyroidism is globally very prevalent at all age groups and represents a non-communicable disease in which the risks and consequences are preventable. In children and adolescents, the most devastating consequences of undertreatment are poor growth and development. Lack of early treatment in congenital hypothyroidism can lead to permanent damage of brain function. In young to middle-aged adults, consequences are often overlooked, and treatment delayed by many years. The resulting consequences are also at this age group compromised brain and physical functioning but less severe and partly reversible with treatment. The undertreated condition often results in a higher risk of several secondary devastating diseases such as increased cardiovascular disease burden, obesity, hypertension, poor physical capacity, poor quality of life. In young women of fertile age the consequences of undertreatment with LT4 are subnormal fertility, recurrent pregnancy loss, preeclampsia, compromised fetal growth and neurocognitive development. There is a further risk of 30-50% of developing postpartum thyroiditis. In the elderly population care must be given to avoid confusing a slightly high serum TSH as result of physiological age adaptation with a requirement for LT4 treatment in a truly hypothyroid patient.
Undertreatment of the preventable non-communicable disease hypothyroidism requires more focus both from caretakers in the healthcare system, but also from the global political systems in order to prevent the personally devastating and socioeconomically challenging consequences.
概述左旋甲状腺素（LT4）治疗不足在常见非传染性疾病——甲状腺功能减退症中的后果。
对文献进行叙述性综述。
甲状腺功能减退症在全球各年龄组均非常普遍，是一种可预防风险和后果的非传染性疾病。在儿童和青少年中，治疗不足最严重的后果是生长和发育不良。先天性甲状腺功能减退症如果未能早期治疗，可能导致脑功能永久性损害。在年轻到中年成年人中，这种疾病往往被忽视，治疗也会被延迟多年。由此产生的后果也会影响这个年龄段的大脑和身体功能，但程度较轻，部分可通过治疗逆转。未经治疗的状况通常会导致多种继发性破坏性疾病的风险增加，如心血管疾病负担增加、肥胖、高血压、身体机能差、生活质量差。在有生育能力的年轻女性中，LT4 治疗不足的后果是生育能力低下、反复流产、子痫前期、胎儿生长和神经认知发育受损。产后甲状腺炎的风险进一步增加 30-50%。在老年人群中，必须注意避免将血清 TSH 略有升高误认为是生理性年龄适应的结果，而忽视了真正甲状腺功能减退患者对 LT4 治疗的需求。
对可预防的非传染性疾病——甲状腺功能减退症的治疗不足需要医护人员以及全球政治系统给予更多关注，以防止对个人造成毁灭性和对社会经济造成挑战的后果。
