Материалы доступны только для специалистов сферы здравоохранения. Авторизуйтесь или зарегистрируйтесь.
Тиреоидиты. Методические рекомендации (в помощь практическому врачу)
Тиреоидиты. Методические рекомендации (в помощь практическому врачу)
Трошина Е.А., Панфилова Е.А., Михина М.С., Свиридонова М.А. Тиреоидиты. Методические рекомендации (в помощь практическому врачу). Consilium Medicum. 2019; 21 (12): 10–22. DOI: 10.26442/20751753.2019.12.190683
________________________________________________
Материалы доступны только для специалистов сферы здравоохранения. Авторизуйтесь или зарегистрируйтесь.
Аннотация
Патология щитовидной железы занимает второе место после сахарного диабета среди эндокринных заболеваний. Всемирной организацией здравоохранения ХХI в. объявлен веком аутоиммунных заболеваний, случаи которых в мире удваиваются каждые 5–10 лет, каждый год сохраняется тенденция и к увеличению аутоиммунных заболеваний щитовидной железы. В методическом руководстве будут рассмотрены вопросы этиологии, патогенеза, клинической картины, диагностики тиреоидитов, сделан акцент на лечение данных заболеваний для повышения качества оказания медицинской помощи.
Ключевые слова: тиреоидит, гипотиреоз, тиреотоксикоз, щитовидная железа, хронический аутоиммунный тиреоидит, острый тиреоидит,
подострый тиреоидит, тиреотропный гормон, антитела, рецептор тиреотропного гормона, тиреопероксидаза, антитела к тиреопероксидазе.
________________________________________________
Among endocrine disorders thyroid disorders take second place after diabetes mellitus. The World Health Organization pronounced ХХI century a century of autoimmune disorders. Incidence of autoimmune disorders doubles every 5–10 years and a tendency to thyroid autoimmune disorders incidence increase is observed. In the guidelines questions of etiology, pathogenesis, clinical presentation, and diagnostics of thyroiditis are discussed. Special focus is made on treatment of these disorders for healthcare quality improvement.
Key words: thyroiditis, hypothyroidism, thyrotoxicosis, thyroid gland, chronic autoimmune thyroiditis, acute thyroiditis, subacute thyroiditis, thyroid stimulating hormone, antibodies, thyroid stimulating hormone receptor, thyroid peroxidase, thyroid peroxidase antibodies.
Полный текст
Список литературы
1. Дедов И.И., Трошина Е.А., Юшков П.В. и др. Диагностика заболеваний щитовидной железы (атлас). М.: Видар, 2000.
[Dedov I.I., Troshina E.A., Yushkov P.V. et al. Diagnosis of thyroid gland diseases (atlas). Moscow: Vidar, 2000 (in Russian).]
2. Дедов И.И., Мельниченко Г.А., Герасимов Г.А. и др. Клинические рекомендации Российской ассоциации эндокринологов по диагностике и лечению аутоиммунного тиреоидита у взрослых. М., 2002.
[Dedov I.I., Melnichenko G.A., Gerasimov G.A. et al. Clinical recommendations of the Russian Association of Endocrinologists on the diagnosis and treatment of autoimmune thyroiditis in adults. Moscow, 2002 (in Russian).]
3. Эндокринология. Национальное руководство. Под ред. И.И.Дедова, Г.А.Мельниченко. М.: ГЭОТАР-Медиа, 2016.
[Endocrinology. National leadership. Ed. I.I.Dedov, G.A.Melnichenko. Moscow: GEOTAR-Media, 2016 (in Russian).]
4. Фадеев В.В. По материалам клинических рекомендаций по субклиническому гипотиреозу Европейской тиреоидной ассоциации 2013 года. Клиническая и экспериментальная тиреоидология. 2013; 9 (4).
[Fadeev V.V. Po materialam klinicheskikh rekomendatsii po subklinicheskomu gipotireozu Evropeiskoi tireoidnoi assotsiatsii 2013 goda. Klinicheskaia i eksperimental'naia tireoidologiia. 2013; 9 (4) (in Russian).]
5. Трошина Е.А., Платонова Н.М., Абдулхабирова Ф.М., Свириденко Н.Ю. Алгоритмы обследования и лечения пациентов в эндокринологии (в схемах). Заболевания щитовидной железы. Справочник поликлинического врача. 2017; 6.
[Troshina E.A., Platonova N.M., Abdulkhabirova F.M., Sviridenko N.Iu. Algoritmy obsledovaniia i lecheniia patsientov v endokrinologii (v skhemakh). Zabolevaniia shchitovidnoi zhelezy. Handbook for Practitioners Doctors. 2017; 6 (in Russian).]
2. Dedov I.I., Melnichenko G.A., Gerasimov G.A. et al. Clinical recommendations of the Russian Association of Endocrinologists on the diagnosis and treatment of autoimmune thyroiditis in adults. Moscow, 2002 (in Russian).
3. Endocrinology. National leadership. Ed. I.I.Dedov, G.A.Melnichenko. Moscow: GEOTAR-Media, 2016 (in Russian).
4. Fadeev V.V. Po materialam klinicheskikh rekomendatsii po subklinicheskomu gipotireozu Evropeiskoi tireoidnoi assotsiatsii 2013 goda. Klinicheskaia i eksperimental'naia tireoidologiia. 2013; 9 (4) (in Russian).
5. Troshina E.A., Platonova N.M., Abdulkhabirova F.M., Sviridenko N.Iu. Algoritmy obsledovaniia i lecheniia patsientov v endokrinologii (v skhemakh). Zabolevaniia shchitovidnoi zhelezy. Handbook for Practitioners Doctors. 2017; 6 (in Russian).
6. Sviridonova M.A., Panfilova E.A., Troshina E.A. Chronic autoimmune thyroiditis. In: Collection of guidelines. Ed. E.A.Troshina. Moscow, 2017 (in Russian).
7. Larina A.A., Troshina E.A., Ivanova O.N. Autoimmune polyglandular syndromes of adults. In: Collection of guidelines. Ed. E.A.Troshina. Moscow, 2017 (in Russian).
8. Tereshchenko I.V., Tsepelev V.V., Ivanova E.S. O subklinicheskom gipotireoze u bol'nykh ishemicheskoi bolezn'iu serdtsa. Kardiologiia. 1993; 33 (11): 45–7 (in Russian).
9. Differential diagnosis of skin diseases. Ed. B.A.Berenbein, A.A.Studnitsina. Moscow, 1989 (in Russian).
10. Jonklaas J, Bianco AC, Bauer AJ et al. Guidelines for the Treatment of Hypothyroidism: Prepared by the American Thyroid Association Task Force on Thyroid Hormone Replacement. Thyroid 2014; 24 (12): 1670–751. DOI: 10.1089/thy.2014.0028
11. Garber JR, Cobin RH, Gharib H et al. Clinical Practice Guidelines for Hypothyroidism in Adults: Cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association. Endocr Pract 2012; 11: 1–207.
12. Bahn RS, Burch HB, Cooper DS et al. Hyperthyroidism and Other Causes of Thyrotoxicosis: Management Guidelines of the American Thyroid Association and American Association of Clinical Endocrinologists. Thyroid 2011; 21.
13. Alexander EK, Pearce EN, Brent GA et al. 2016 Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease during Pregnancy and the Postpartum. DOI: 10.1089/thy.2016.0457
14. Pearce SH, Brabant G, Duntas L et al. 2013 ETA Guideline: Management of Subclinical Hypothyroidism. Eur Thyroid J 2013; 2: 215–28.
15. Stagnaro-Green A, Abalovich M, Alexander E et al. Guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and postpartum. American Thyroid Association Taskforce on Thyroid Disease during Pregnancy and Postpartum. Thyroid 2011; 21: 1081–125.
16. Lazarus J, Brown RS, Daumerie C et al. European Thyroid Association Guidelines for the Management of Subclinical Hypothyroidism in Pregnancy and in Children. Eur Thyroid J 2014.
[Dedov I.I., Troshina E.A., Yushkov P.V. et al. Diagnosis of thyroid gland diseases (atlas). Moscow: Vidar, 2000 (in Russian).]
2. Дедов И.И., Мельниченко Г.А., Герасимов Г.А. и др. Клинические рекомендации Российской ассоциации эндокринологов по диагностике и лечению аутоиммунного тиреоидита у взрослых. М., 2002.
[Dedov I.I., Melnichenko G.A., Gerasimov G.A. et al. Clinical recommendations of the Russian Association of Endocrinologists on the diagnosis and treatment of autoimmune thyroiditis in adults. Moscow, 2002 (in Russian).]
3. Эндокринология. Национальное руководство. Под ред. И.И.Дедова, Г.А.Мельниченко. М.: ГЭОТАР-Медиа, 2016.
[Endocrinology. National leadership. Ed. I.I.Dedov, G.A.Melnichenko. Moscow: GEOTAR-Media, 2016 (in Russian).]
4. Фадеев В.В. По материалам клинических рекомендаций по субклиническому гипотиреозу Европейской тиреоидной ассоциации 2013 года. Клиническая и экспериментальная тиреоидология. 2013; 9 (4).
[Fadeev V.V. Po materialam klinicheskikh rekomendatsii po subklinicheskomu gipotireozu Evropeiskoi tireoidnoi assotsiatsii 2013 goda. Klinicheskaia i eksperimental'naia tireoidologiia. 2013; 9 (4) (in Russian).]
5. Трошина Е.А., Платонова Н.М., Абдулхабирова Ф.М., Свириденко Н.Ю. Алгоритмы обследования и лечения пациентов в эндокринологии (в схемах). Заболевания щитовидной железы. Справочник поликлинического врача. 2017; 6.
[Troshina E.A., Platonova N.M., Abdulkhabirova F.M., Sviridenko N.Iu. Algoritmy obsledovaniia i lecheniia patsientov v endokrinologii (v skhemakh). Zabolevaniia shchitovidnoi zhelezy. Handbook for Practitioners Doctors. 2017; 6 (in Russian).]
6. Свиридонова М.А., Панфилова Е.А., Трошина Е.А. Хронический аутоиммунный тиреоидит. В кн.: Сборник методических рекомендаций. Под ред. Е.А.Трошиной. М., 2017.
[Sviridonova M.A., Panfilova E.A., Troshina E.A. Chronic autoimmune thyroiditis. In: Collection of guidelines. Ed. E.A.Troshina. Moscow, 2017 (in Russian).]
7. Ларина А.А., Трошина Е.А., Иванова О.Н. Аутоиммунные полигландулярные синдромы взрослых. В кн.: Сборник методических рекомендаций. Под ред. Е.А.Трошиной. М., 2017.
[Larina A.A., Troshina E.A., Ivanova O.N. Autoimmune polyglandular syndromes of adults. In: Collection of guidelines. Ed. E.A.Troshina. Moscow, 2017 (in Russian).]
8. Терещенко И.В., Цепелев В.В., Иванова Э.С. О субклиническом гипотиреозе у больных ишемической болезнью сердца. Кардиология. 1993; 33 (11): 45–7.
[Tereshchenko I.V., Tsepelev V.V., Ivanova E.S. O subklinicheskom gipotireoze u bol'nykh ishemicheskoi bolezn'iu serdtsa. Kardiologiia. 1993; 33 (11): 45–7 (in Russian).]
9. Дифференциальная диагностика кожных болезней. Под ред. Б.А.Беренбейна, А.А.Студницина. М., 1989.
[Differential diagnosis of skin diseases. Ed. B.A.Berenbein, A.A.Studnitsina. Moscow, 1989 (in Russian).]
10. Jonklaas J, Bianco AC, Bauer AJ et al. Guidelines for the Treatment of Hypothyroidism: Prepared by the American Thyroid Association Task Force on Thyroid Hormone Replacement. Thyroid 2014; 24 (12): 1670–751. DOI: 10.1089/thy.2014.0028
11. Garber JR, Cobin RH, Gharib H et al. Clinical Practice Guidelines for Hypothyroidism in Adults: Cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association. Endocr Pract 2012; 11: 1–207.
12. Bahn RS, Burch HB, Cooper DS et al. Hyperthyroidism and Other Causes of Thyrotoxicosis: Management Guidelines of the American Thyroid Association and American Association of Clinical Endocrinologists. Thyroid 2011; 21.
13. Alexander EK, Pearce EN, Brent GA et al. 2016 Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease during Pregnancy and the Postpartum. DOI: 10.1089/thy.2016.0457
14. Pearce SH, Brabant G, Duntas L et al. 2013 ETA Guideline: Management of Subclinical Hypothyroidism. Eur Thyroid J 2013; 2: 215–28.
15. Stagnaro-Green A, Abalovich M, Alexander E et al. Guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and postpartum. American Thyroid Association Taskforce on Thyroid Disease during Pregnancy and Postpartum. Thyroid 2011; 21: 1081–125.
16. Lazarus J, Brown RS, Daumerie C et al. European Thyroid Association Guidelines for the Management of Subclinical Hypothyroidism in Pregnancy and in Children. Eur Thyroid J 2014.
[Larina A.A., Troshina E.A., Ivanova O.N. Autoimmune polyglandular syndromes of adults. In: Collection of guidelines. Ed. E.A.Troshina. Moscow, 2017 (in Russian).]
8. Терещенко И.В., Цепелев В.В., Иванова Э.С. О субклиническом гипотиреозе у больных ишемической болезнью сердца. Кардиология. 1993; 33 (11): 45–7.
[Tereshchenko I.V., Tsepelev V.V., Ivanova E.S. O subklinicheskom gipotireoze u bol'nykh ishemicheskoi bolezn'iu serdtsa. Kardiologiia. 1993; 33 (11): 45–7 (in Russian).]
9. Дифференциальная диагностика кожных болезней. Под ред. Б.А.Беренбейна, А.А.Студницина. М., 1989.
[Differential diagnosis of skin diseases. Ed. B.A.Berenbein, A.A.Studnitsina. Moscow, 1989 (in Russian).]
10. Jonklaas J, Bianco AC, Bauer AJ et al. Guidelines for the Treatment of Hypothyroidism: Prepared by the American Thyroid Association Task Force on Thyroid Hormone Replacement. Thyroid 2014; 24 (12): 1670–751. DOI: 10.1089/thy.2014.0028
11. Garber JR, Cobin RH, Gharib H et al. Clinical Practice Guidelines for Hypothyroidism in Adults: Cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association. Endocr Pract 2012; 11: 1–207.
12. Bahn RS, Burch HB, Cooper DS et al. Hyperthyroidism and Other Causes of Thyrotoxicosis: Management Guidelines of the American Thyroid Association and American Association of Clinical Endocrinologists. Thyroid 2011; 21.
13. Alexander EK, Pearce EN, Brent GA et al. 2016 Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease during Pregnancy and the Postpartum. DOI: 10.1089/thy.2016.0457
14. Pearce SH, Brabant G, Duntas L et al. 2013 ETA Guideline: Management of Subclinical Hypothyroidism. Eur Thyroid J 2013; 2: 215–28.
15. Stagnaro-Green A, Abalovich M, Alexander E et al. Guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and postpartum. American Thyroid Association Taskforce on Thyroid Disease during Pregnancy and Postpartum. Thyroid 2011; 21: 1081–125.
16. Lazarus J, Brown RS, Daumerie C et al. European Thyroid Association Guidelines for the Management of Subclinical Hypothyroidism in Pregnancy and in Children. Eur Thyroid J 2014.
________________________________________________
2. Dedov I.I., Melnichenko G.A., Gerasimov G.A. et al. Clinical recommendations of the Russian Association of Endocrinologists on the diagnosis and treatment of autoimmune thyroiditis in adults. Moscow, 2002 (in Russian).
3. Endocrinology. National leadership. Ed. I.I.Dedov, G.A.Melnichenko. Moscow: GEOTAR-Media, 2016 (in Russian).
4. Fadeev V.V. Po materialam klinicheskikh rekomendatsii po subklinicheskomu gipotireozu Evropeiskoi tireoidnoi assotsiatsii 2013 goda. Klinicheskaia i eksperimental'naia tireoidologiia. 2013; 9 (4) (in Russian).
5. Troshina E.A., Platonova N.M., Abdulkhabirova F.M., Sviridenko N.Iu. Algoritmy obsledovaniia i lecheniia patsientov v endokrinologii (v skhemakh). Zabolevaniia shchitovidnoi zhelezy. Handbook for Practitioners Doctors. 2017; 6 (in Russian).
6. Sviridonova M.A., Panfilova E.A., Troshina E.A. Chronic autoimmune thyroiditis. In: Collection of guidelines. Ed. E.A.Troshina. Moscow, 2017 (in Russian).
7. Larina A.A., Troshina E.A., Ivanova O.N. Autoimmune polyglandular syndromes of adults. In: Collection of guidelines. Ed. E.A.Troshina. Moscow, 2017 (in Russian).
8. Tereshchenko I.V., Tsepelev V.V., Ivanova E.S. O subklinicheskom gipotireoze u bol'nykh ishemicheskoi bolezn'iu serdtsa. Kardiologiia. 1993; 33 (11): 45–7 (in Russian).
9. Differential diagnosis of skin diseases. Ed. B.A.Berenbein, A.A.Studnitsina. Moscow, 1989 (in Russian).
10. Jonklaas J, Bianco AC, Bauer AJ et al. Guidelines for the Treatment of Hypothyroidism: Prepared by the American Thyroid Association Task Force on Thyroid Hormone Replacement. Thyroid 2014; 24 (12): 1670–751. DOI: 10.1089/thy.2014.0028
11. Garber JR, Cobin RH, Gharib H et al. Clinical Practice Guidelines for Hypothyroidism in Adults: Cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association. Endocr Pract 2012; 11: 1–207.
12. Bahn RS, Burch HB, Cooper DS et al. Hyperthyroidism and Other Causes of Thyrotoxicosis: Management Guidelines of the American Thyroid Association and American Association of Clinical Endocrinologists. Thyroid 2011; 21.
13. Alexander EK, Pearce EN, Brent GA et al. 2016 Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease during Pregnancy and the Postpartum. DOI: 10.1089/thy.2016.0457
14. Pearce SH, Brabant G, Duntas L et al. 2013 ETA Guideline: Management of Subclinical Hypothyroidism. Eur Thyroid J 2013; 2: 215–28.
15. Stagnaro-Green A, Abalovich M, Alexander E et al. Guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and postpartum. American Thyroid Association Taskforce on Thyroid Disease during Pregnancy and Postpartum. Thyroid 2011; 21: 1081–125.
16. Lazarus J, Brown RS, Daumerie C et al. European Thyroid Association Guidelines for the Management of Subclinical Hypothyroidism in Pregnancy and in Children. Eur Thyroid J 2014.
Авторы
Е.А. Трошина, Е.А. Панфилова, М.С. Михина, М.А. Свиридонова
ФГБУ «Национальный медицинский исследовательский центр эндокринологии» Минздрава России, Москва, Россия
*troshina@inbox.ru
________________________________________________
Ekaterina A. Troshina*, Elena A. Panfilova, Margarita S. Mikhina, Marina A. Sviridonova
National Medical Research Center for Endocrinology, Moscow, Russia
*troshina@inbox.ru
Цель портала OmniDoctor – предоставление профессиональной информации врачам, провизорам и фармацевтам.