Stempler Márk, Bakos Bence, Solymosi Tibor, Kiss András, Ármós Richárd Levente, Szili Balázs, Mészáros Szilvia, Tőke Judit, Szűcs Nikolette, Reismann Péter, Péter Pusztai, Lakatos Péter András, Takács István
Department of Internal Medicine and Oncology, Semmelweis University, 1083, Budapest, Korányi Sándor utca 2/a, Hungary.
Department of Internal Medicine and Haematology, Semmelweis University, Szentkirályi u. 46, Budapest, 1088, Hungary.
Heliyon. 2024 Oct 19;10(20):e39639. doi: 10.1016/j.heliyon.2024.e39639. eCollection 2024 Oct 30.
The mainstay therapy of hypothyroidism is levothyroxine (LT4). In most cases lifelong treatment is warranted, therefore, choosing adequate doses are of paramount significance. The purpose of this study was to assess several factors that have been proposed to influence LT4 therapy including etiology of hypothyroidism, gender, age, bodyweight, BMI, concomitant drug use, disease severity and time since diagnosis in patients with stable, adequately controlled hypothyroidism.
In this cross-sectional study we analysed past medical history, anthropometric data and biochemical parameters reflecting thyroid function of patients with chronic hypothyroidism who were adequately treated (TSH levels in normal range) with LT4 for at least 6 months. Potential predictors of LT4 requirement were evaluated using uni- and multivariate linear modelling.
191 individuals were enrolled in this study, who were divided into autoimmune (n = 147) and post-surgery (n = 44) groups. Mean age, time since diagnosis and LT4 dose (1.3 versus 1.1 mcg/kgBW) were significantly lower in the autoimmune group. In the post-surgery group age was the only significant (p = 0.016) predictor of LT4 dose. In the autoimmune group BMI (p = 0.001), time since diagnosis (p = 0.023), as well as their interaction (p = 0.012) turned out to be significant predictors of LT4 requirement.
Our results implicate the necessity of differentiating between etiologies of hypothyroidism when starting or changing thyroxine replacement therapy. Patient in both groups required significantly lower doses of LT4 replacement, than previous reports suggest, to maintain stable euthyroidism. Distinctly different factors predicted hormone requirement in the two study groups.
甲状腺功能减退症的主要治疗方法是左甲状腺素（LT4）。在大多数情况下，需要终身治疗，因此，选择合适的剂量至关重要。本研究的目的是评估一些被认为会影响LT4治疗的因素，包括甲状腺功能减退症的病因、性别、年龄、体重、体重指数（BMI）、合并用药、疾病严重程度以及确诊后时间，这些因素来自甲状腺功能减退症病情稳定且得到充分控制的患者。
在这项横断面研究中，我们分析了慢性甲状腺功能减退症患者的既往病史、人体测量数据和反映甲状腺功能的生化参数，这些患者接受LT4充分治疗（促甲状腺激素水平在正常范围内）至少6个月。使用单变量和多变量线性模型评估LT4需求量的潜在预测因素。
本研究共纳入191名个体，分为自身免疫性（n = 147）和手术后（n = 44）两组。自身免疫性组的平均年龄、确诊后时间和LT4剂量（1.3 微克/千克体重对1.1微克/千克体重）显著更低。在手术后组，年龄是LT4剂量的唯一显著（p = 0.016）预测因素。在自身免疫性组，BMI（p = 0.001）、确诊后时间（p = 0.023）及其相互作用（p = 0.012）是LT4需求量的显著预测因素。
我们的结果表明，在开始或改变甲状腺素替代治疗时，区分甲状腺功能减退症的病因很有必要。两组患者维持稳定的甲状腺功能正常所需的LT4替代剂量均显著低于先前报告的剂量。两个研究组预测激素需求量的因素明显不同。
