甲状腺素与甲状腺素加三碘甲状腺原氨酸对甲状腺功能减退患者的影响比较。

Effects of thyroxine as compared with thyroxine plus triiodothyronine in patients with hypothyroidism.

作者信息

Bunevicius R, Kazanavicius G, Zalinkevicius R, Prange A J

机构信息

Institute of Endocrinology, Kaunas Medical University, Lithuania.

出版信息

N Engl J Med. 1999 Feb 11;340(6):424-9. doi: 10.1056/NEJM199902113400603.

DOI:10.1056/NEJM199902113400603

PMID:9971866

Abstract

BACKGROUND

Patients with hypothyroidism are usually treated with thyroxine (levothyroxine) only, although both thyroxine and triiodothyronine are secreted by the normal thyroid gland. Whether thyroid secretion of triiodothyronine is physiologically important is unknown.

METHODS

We compared the effects of thyroxine alone with those of thyroxine plus triiodothyronine (liothyronine) in 33 patients with hypothyroidism. Each patient was studied for two five-week periods. During one period, the patient received his or her usual dose of thyroxine. During the other, the patient received a regimen in which 50 microg of the usual dose of thyroxine was replaced by 12.5 microg of triiodothyronine. The order in which each patient received the two treatments was randomized. Biochemical, physiologic, and psychological tests were performed at the end of each treatment period.

RESULTS

The patients had lower serum free and total thyroxine concentrations and higher serum total triiodothyronine concentrations after treatment with thyroxine plus triiodothyronine than after thyroxine alone, whereas the serum thyrotropin concentrations were similar after both treatments. Among 17 scores on tests of cognitive performance and assessments of mood, 6 were better or closer to normal after treatment with thyroxine plus triiodothyronine. Similarly, among 15 visual-analogue scales used to indicate mood and physical status, the results for 10 were significantly better after treatment with thyroxine plus triiodothyronine. The pulse rate and serum sex hormone-binding globulin concentrations were slightly higher after treatment with thyroxine plus triiodothyronine, but blood pressure, serum lipid concentrations, and the results of neurophysiologic tests were similar after the two treatments.

CONCLUSIONS

In patients with hypothyroidism, partial substitution of triiodothyronine for thyroxine may improve mood and neuropsychological function; this finding suggests a specific effect of the triiodothyronine normally secreted by the thyroid gland.

摘要

背景

甲状腺功能减退患者通常仅接受甲状腺素（左甲状腺素）治疗，尽管正常甲状腺会同时分泌甲状腺素和三碘甲状腺原氨酸。三碘甲状腺原氨酸的甲状腺分泌在生理上是否重要尚不清楚。

方法

我们比较了33例甲状腺功能减退患者单独使用甲状腺素与使用甲状腺素加三碘甲状腺原氨酸（碘塞罗宁）的效果。每位患者接受两个为期五周的研究阶段。在一个阶段，患者接受其常规剂量的甲状腺素。在另一个阶段，患者接受一种治疗方案，其中将常规剂量甲状腺素的50微克替换为12.5微克的三碘甲状腺原氨酸。每位患者接受两种治疗的顺序是随机的。在每个治疗阶段结束时进行生化、生理和心理测试。

结果

与单独使用甲状腺素治疗后相比，甲状腺素加三碘甲状腺原氨酸治疗后患者的血清游离甲状腺素和总甲状腺素浓度较低，血清总三碘甲状腺原氨酸浓度较高，而两种治疗后血清促甲状腺激素浓度相似。在17项认知表现测试和情绪评估得分中，6项在甲状腺素加三碘甲状腺原氨酸治疗后更好或更接近正常水平。同样，在用于指示情绪和身体状况的15个视觉模拟量表中，10项在甲状腺素加三碘甲状腺原氨酸治疗后的结果明显更好。甲状腺素加三碘甲状腺原氨酸治疗后脉搏率和血清性激素结合球蛋白浓度略高，但两种治疗后血压、血脂浓度和神经生理学测试结果相似。