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Гипотиреоз: от диагностики к успеху терапии
Гипотиреоз: от диагностики к успеху терапии
Бирюкова Е.В., Абрамова А.Д. Гипотиреоз: от диагностики к успеху терапии. Consilium Medicum. 2025;27(4):210–217. DOI: 10.26442/20751753.2025.4.203294
© ООО «КОНСИЛИУМ МЕДИКУМ», 2025 г.
© ООО «КОНСИЛИУМ МЕДИКУМ», 2025 г.
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Аннотация
Гипотиреоз является одним из частых нарушений функции щитовидной железы (ЩЖ). В статье отражаются вопросы эпидемиологии, классификации гипотиреоза. Причины возникновения гипотиреоза могут быть различными. Дефицит гормонов ЩЖ приводит к нарушению работы множества органов и систем, что проявляется многочисленными симптомами, которые могут быть неспецифическими и имитировать другие заболевания. Недиагностированный гипотиреоз является фактором риска прогрессирования уже имеющихся сердечно-сосудистых заболеваний. Частота встречаемости этой патологии ЩЖ определяется полом и возрастом больных. Рассматриваются основные причины первичного и вторичного гипотиреозов. Самая частая причина первичного гипотиреоза – аутоиммунный тиреоидит, который может развиваться как отдельно, так и одновременно с другими аутоиммунными заболеваниями, в рамках полигландулярного синдрома. К причинам развития гипотиреоза относят хирургическое лечение патологии ЩЖ и ее аблацию. При деструктивных тиреоидитах (послеродовом и иных) может развиться транзиторный гипотиреоз. Обсуждаются вопросы тиреоидной недостаточности, развившейся в виде неблагоприятной побочной реакции при использовании ряда лекарственных средств. Описывается клиническая симптоматика гипотиреоза. Тяжесть клинических проявлений определяется выраженностью дефицита тиреоидных гормонов. Первичный гипотиреоз по степени тяжести классифицируется на субклинический и манифестный. Существенных клинических отличий между выраженными формами первичного и вторичного гипотиреозов нет. Вторичный гипотиреоз может сочетаться с другими проявлениями гипоталамо-гипофизарных нарушений. Обсуждаются сложности диагностики гипотиреоза, который может протекать под «маской» другого заболевания. Окончательный диагноз уточняется рядом лабораторных и инструментальных исследований. Для субклинического гипотиреоза характерно повышение концентрации тиреотропного гормона (ТТГ) при нормальном уровне свободного тироксина (свТ4), для манифестного гипотиреоза – повышение концентрации ТТГ и снижение концентрации свТ4. При вторичном гипотиреозе отмечается снижение концентрации ТТГ и свТ4. Для лечения гипотиреоза любой этиологии используется заместительная терапия левотироксином натрия (L-T4).
Ключевые слова: гипотиреоз, аутоиммунный тиреоидит, тиреотропный гормон, тиреоидные гормоны, медикаментозно-индуцированный гипотиреоз, заместительная терапия, левотироксин натрия
Keywords: hypothyroidism, autoimmune thyroiditis, thyroid-stimulating hormone, thyroid hormones, drug-induced hypothyroidism, replacement therapy, levothyroxine sodium
Ключевые слова: гипотиреоз, аутоиммунный тиреоидит, тиреотропный гормон, тиреоидные гормоны, медикаментозно-индуцированный гипотиреоз, заместительная терапия, левотироксин натрия
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Keywords: hypothyroidism, autoimmune thyroiditis, thyroid-stimulating hormone, thyroid hormones, drug-induced hypothyroidism, replacement therapy, levothyroxine sodium
Полный текст
Список литературы
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11. Aoki Y, Belin RM, Clickner R, et al. Serum TSH and total T4 in the United States population and their association with participant characteristics: National Health and Nutrition Examination Survey (NHANES 1999–2002). Thyroid. 2007;17(12):1211-23. DOI:10.1089/thy.2006.0235
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14. Cooper DS, Biondi B. Subclinical thyroid disease. Lancet. 2012;379(9821):1142-54. DOI:10.1016/s0140-6736(11)60276-6
15. Yoo WS, Chung HK. Subclinical hypothyroidism: Prevalence, health impact, and treatment landscape. Endocrinol Metab. 2021;36(3):500-13. DOI:10.3803/EnM.2021.1066
16. Caturegli P, De Remigis A, Rose NR. Hashimoto thyroiditis: Clinical and diagnostic criteria. Autoimmun Rev. 2014;13(4-5):391-7. DOI:10.1016/j.autrev.2014.01.007
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18. Fadeev VV, Morgunova TB, Melnichenko GA, Dedov II. Draft of the clinical recommendations for diagnosis and treatment of hypothyroidism. Clinical and Experimental Thyroidology. 2021;17(1):4-13 (in Russian). DOI:10.14341/ket12702
19. Park S, Jeon MJ, Song E, et al. Clinical features of early and late postoperative hypothyroidism after lobectomy. J Clin Endocrinol Metab. 2017;102(4):1317-24. DOI:10.1210/jc.2016-3597
20. Verloop H, Louwerens M, Schoones JW, et al. Risk of hypothyroidism following hemithyroidectomy: Systematic review and meta-analysis of prognostic studies. J Clin Endocrinol Metab. 2012;97(7):2243-55. DOI:10.1210/jc.2012-1063
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22. Reiners C, Drozd V, Yamashita S. Hypothyroidism after radiation exposure: Brief narrative review. J Neural Transm (Vienna). 2020;9;127(11):1455-66. DOI:10.1007/s00 702-020-02260-5
23. Grunenwald S, Caron P. Central hypothyroidism in adults: Better understanding for better care. Pituitary. 2015;18(1):169-75. DOI:10.1007/s11102-014-0559-8
24. Persani L. Clinical review: Central hypothyroidism: Pathogenic, diagnostic, and therapeutic challenges. J Clin Endocrinol Metab. 2012;97(9):3068-78. DOI:10.1210/jc.2012-1616
25. Zhipeng W, Hongsen W, Chen B. Tyrosine kinase inhibitor-induced hypothyroidism: Mechanism and clinical implications. Eur J Clin Pharmacol. 2024;80(6):827-38. DOI:10.1007/s00228-024-03626-4
26. Laurberg P, Andersen S, Bülow Pedersen I, Carlé A. Hypothyroidism in the elderly: Pathophysiology, diagnosis and treatment. Drugs Aging. 2005;22(1):23-38. DOI:10.2165/00002512-200522010-00002
27. Zhong B, Wang Y, Zhang G, Wang Z. Environmental iodine content, female sex and age are associated with new-onset amiodarone-induced hypothyroidism: A systematic review and meta-analysis of adverse reactions of amiodarone on the thyroid. Cardiology. 2016;134(3):366-71. DOI:10.1159/000444578
28. Burch HB. Drugs affecting thyroid function. N Engl J Med. 2019;381(8):749-61. DOI:10.1056/NEJMra1901214
29. Rizzo LFL, Mana DL, Serra HA. Drug-induced hypothyroidism. Medicina (B Aires). 2017;77(5):394-404. PMID:29044016
30. Philippou G, Koutras DA, Piperingos G, et al. The effect of iodide on serum thyroid hormone levels in normal persons, in hyperthyroid patients, and in hypothyroid patients on thyroxine replacement. Clin Endocrinol (Oxf). 1992;36(6):573-8. DOI:10.1111/j.1365-2265.1992.tb02267
31. Lee SY, Rhee CM, Leung AM, et al. A review: Radiographic iodinated contrast-induced thyroid dysfunction. J Clin Endocrinol Metab. 2015;100(2):376-83. DOI:10.1210/jc.2014-3292
32. Kornelius E, Chiou JY, Yang YS, et al. Iodinated contrast media increased the risk of thyroid dysfunction: A 6-year retrospective cohort study. J Clin Endocrinol Metab. 2015;100(9):3372-9. DOI:10.1210/jc.2015-2329
33. Bartalena L, Bogazzi F, Chiovato C. 2018 European Thyroid Association (ETA) Guidelines for the management of amiodarone-associated thyroid dysfunction. Eur Thyroid J. 2018;7(2):55-66. DOI:10.1159/000486957
34. Cooper DS. Antithyroid drugs. N Engl J Med. 2005;352(9):905-17. DOI:10.1056/nejmra042972
35. Glibka AA, Mazurina NV, Sarantseva KA, et al. Thyroid disorders induced by immune checkpoint inhibitors therapy of malignant tumors. Almanac of Clinical Medicine. 2022;50(3):187-95 (in Russian). DOI:10.18786/2072-0505-2022-50-020
36. Zherebchikova KYu, Sych YuP, Amosova MV, et al. Endocrine adverse events in patients with malignant neoplasms receiving treatment with immune checkpoint inhibitors. Russian Medical Inquiry. 2022;6(9):528-33 (in Russian). DOI:10.32364/2587-6821-2022-6-9-528-533
37. Boelaert K. Thyroid dysfunction in the elderly. Nature Rev Endocrinol. 2013;9(4):194-204. DOI:10.1038/nrendo.2013.30
38. Hall R, Scanlon MF. Hypothyroidism: Clinical features and complications. Clin Endocrinol Metab. 1979;8(1):29-38. DOI:10.1016/s0300-595x(79)80007-9
39. Carlé A, Pedersen IB, Knudsen N, et al. Hypothyroid symptoms fail to predict thyroid insufficiency in old people: A population-based case-control study. Am J Med. 2016;129(10):1082-92. DOI:10.1016/j.amjmed.2016.06.013
40. Grais IM, Sowers JR. Thyroid and the heart. Am J Med. 2014;127(8):691-8. DOI:10.1016/j.amjmed.2014.03.009
41. Faber J, Selmer C. Cardiovascular disease and thyroid function. Front Horm Res. 2014;43:45-56. DOI:10.1159/000360558
42. Hernando VU, Eliana MS. Role of thyroid hormones in different aspects of cardiovascular system. Endocrinol Metab Synd. 2015;4(2):166. DOI:10.4172/2161-1017.1000166
43. Artantaş S, Gül U, Kiliç A, Güler S. Skin findings in thyroid diseases. Eur J Intern Med. 2009;209(2):158-61. DOI:10.1016/j.ejim.2007.09.021
44. Udovcic M, Pena RH, Patham B, et al. Hypothyroidism and the Heart. Methodist Debakey Cardiovasc J. 2017;13(2):55-9. DOI:10.14797/mdcj-13-2-55
45. Lu S, Guan Q, Liu Y, et al. Role of extrathyroidal TSHR expression in adipocyte differentiation and its association with obesity. Lipids Health Dis. 2012;11:17. DOI:10.1186/1476-511x-11-17
46. Kim B. Thyroid hormone as a determinant of energy expenditure and the basal metabolic rate. Thyroid. 2008;18(2):141-4. DOI:10.1089/thy.2007.0266
47. Grunstein RR, Sullivan CE. Sleep apnea and hypothyroidism: Mechanisms and management. Am J Med. 1988;85(6):775-9. DOI:10.1016/s0002-9343(88)80020-2
48. de Carvalho GA, Fighera TM. Effect of gastrointestinal disorders in autoimmune thyroid diseases. Transl Gastrointest Cancer. 2015;4(1):76-82.
49. Rhee CK. The interaction between thyroid and kidney disease: An overview of the evidence. Curr Opin Endocrinol Diabetes Obes. 2016;23(5):407-15. DOI:10.1097/MED.0000000000000275
50. De Sousa A, Shrivastava A. Neurocognition and hypothyroidism: Critical points. Ann Indian Psychiatry. 2017;1(2):118-9. DOI:10.4103/aip.aip_26_17
51. Esina MM. System of reproduction in hypothyreosis. V.F. Snegirev Archives of Obstetrics and Gynecology, Russian journal. 2017;4(2):77-83 (in Russian). DOI:10.18821/2313-8726-2017-4-2-77-83
52. Honbo KS, van Herle AJ, Kellett KA. Serum prolactin levels in untreated primary hypothyroidism. Am J Med. 1978;64(5):782-7. DOI:10.1016/0002-9343(78)90517-x
53. Ben-Jonathan N, Hnasko R. Dopamine as a prolactin inhibitor. Endocrine Rewiews. 2001;22(6):724-63. DOI:10.1210/edrv.22.6.0451
54. Collins AB, Pawlak R. Prevalence of vitamin B-12 deficiency among patients with thyroid dysfunction. Asia Pac J Clin Nutr. 2016;25(2):221-6. DOI:10.6133/apjcn.2016. 25.2.22
55. Yamada M, Mori M. Mechanisms related to the pathophysiology and management of central hypothyroidism. Nat Clin Pract Endocrinol Metab. 2008;4(12):683-94. DOI:10.1038/ncpendmet0995
56. O'Leary PC, Feddema PH, Michelangeli VP, et al. Investigations of thyroid hormones and anti-bodies based on a community health survey: The Busselton thyroid study. Clin Endocrinol. 2006;64(1):97-104. DOI:10.1111/j.1365-2265.2005.02424.x
57. Joshi AS, Woolf PD. Pituitary hyperplasia secondary to primary hypothyroidism: A case report and review of the literature. Pituitary. 2005;8(2):99-103. DOI:10.1007/s11102-005-3281-8
58. Clarke N, Kabadi UM. Optimizing treatment of hypothyroidism. Treat Endocrinol. 2004;3(4):217-21. DOI:10.2165/00024677-200403040-00003
59. Hueston WJ. Treatment of hypothyroidism. Am Fam Physician. 2001;64(10):1717-24. PMID:11759078
60. 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
61. Gaitonde DY, Rowley KD, Sweeney LB. Hypothyroidism: An update. Am Fam Physician. 2012;86(3):244-51. PMID:22962987
62. Virili C, Antonelli A, Santaguida MG, et al. Gastrointestinal malabsorption of thyroxine. Endocrine Reviews. 2019;40(1):118-36. DOI:10.1210/er.2018-00168
63. McMillan M, Rotenberg KS, Vora K. Comorbidities, concomitant medications, and diet as factors affecting levothyroxine therapy: Results of the CONTROL surveillance project. Drugs R D. 2016;16:53-68. DOI:10.1007/s40268-015-0116-6
64. Lahner E, Virili C, Santaguida MG, et al. Helicobacter pylori infection and drugs malabsorption. World J Gastroenterol. 2014;20(30):10331-7. DOI:10.3748/wjg.v20.i30.10331
65. Barbesino G. Drugs affecting thyroid function. Thyroid. 2010;20(7):763-70. DOI:10.1089/thy.2010.1635
66. Arafah BM. Increased need for thyroxine in women with hypothyroidism during es
2. Taylor PN, Medici MM, Hubalewska-Dydejczyk A, Boelaert K. Hypothyroidism. Lancet. 2024;404(10460):1347-64. DOI:10.1016/S0140-6736(24)01614-3
3. Резник Е.В., Годило-Годлевский В.А., Зайнуллина Ю.И., и др. Драматический исход поздней диагностики хронического аутоиммунного тиреоидита с первичным гипотиреозом тяжелой степени. Архивъ внутренней медицины. 2023;13(2):144-54 [Reznik EV, Godilo-Godlevsky VA, Zaynullina YI, et al. The dramatic outcome of the late diagnosis of the chronic autoimmune thyroiditis with the severe primary hypothyroidism. The Russian Archives of Internal Medicine. 2023;13(2):144-54 (in Russian)]. DOI:10.20514/2226-6704-2023-13-2-144-154
4. Lindholm J, Laurberg P. Hypothyroidism and thyroid substitution: Historical aspects. J Thyroid Res. 2011;2011:1-10. DOI:10.4061/2011/809341
5. Chaker L, Bianco AC, Jonklaas J, Peeters RP. Hypothyroidism. Lancet. 2017;390(1010 1):1550-62. DOI:10.1016/S0140-6736(17)30703-1
6. Hegedüs L, Bianco AC, Jonklaas J, et al. Primary hypothyroidism and quality of life. Nat Rev Endocrinol. 2022;18(4):230-42. DOI:10.1038/s41574-021-00625-8
7. Feldt-Rasmussen U, Effraimidis G, Bliddal S, Klose M. Consequences of undertreatment of hypothyroidism. Endocrine. 2024;84(2):301-8. DOI:10.1007/s12020-023-03460-1
8. Taylor PN, Iqbal A, Minassian C, et al. Falling threshold for treatment of borderline elevated thyrotropin levels-balancing benefits and risks: Evidence from a large community-based study. JAMA Intern Med. 2014;174(1):32-9. DOI:0.1001/jamainternmed.20 13.11312
9. Мануйлова Ю.А., Моргунова Т.Б., Фадеев В.В. Причины неэффективности заместительной терапии первичного гипотиреоза. Клиническая и экспериментальная тиреоидология. 2019;15(1):12-8 [Manuylova YuA, Morgunova TB, Fadeyev VV. Causes of treatment failure in primary hypothyroidism. Clinical and Experimental Thyroidology. 2019;15(1):12-8 (in Russian)]. DOI:10.14341/ket10163
10. Roberts CG, Ladenson PW. Hypothyroidism. Lancet. 2004;363(9411):793-803. DOI:10.1016/s0140-6736(04)15696-1
11. Aoki Y, Belin RM, Clickner R, et al. Serum TSH and total T4 in the United States population and their association with participant characteristics: National Health and Nutrition Examination Survey (NHANES 1999–2002). Thyroid. 2007;17(12):1211-23. DOI:10.1089/thy.2006.0235
12. Garmendia Madariaga A, Santos Palacios S, Guillén-Grima F, Galofré JC. The incidence and prevalence of thyroid dysfunction in Europe: A meta-analysis. J Clin Endocrinol Metab. 2014;99(3):923-31. DOI:10.1210/jc.2013-2409
13. Benvenga S, Papi G, Antonelli A. Refractory hypothyroidism due to improper storage of levothyroxine tablets. Front Endocrinol (Lausanne). 2017;8:155. DOI:10.3389/fendo.2017.00155
14. Cooper DS, Biondi B. Subclinical thyroid disease. Lancet. 2012;379(9821):1142-54. DOI:10.1016/s0140-6736(11)60276-6
15. Yoo WS, Chung HK. Subclinical hypothyroidism: Prevalence, health impact, and treatment landscape. Endocrinol Metab. 2021;36(3):500-13. DOI:10.3803/EnM.2021.1066
16. Caturegli P, De Remigis A, Rose NR. Hashimoto thyroiditis: Clinical and diagnostic criteria. Autoimmun Rev. 2014;13(4-5):391-7. DOI:10.1016/j.autrev.2014.01.007
17. Effraimidis G, Wiersinga WM. Mechanisms in endocrinology: Autoimmune thyroid disease: Old and new players. Eur J Endocrinol. 2014;170(6):R241-52. DOI:10.1530/EJE-14-0047
18. Фадеев В.В., Моргунова Т.Б., Мельниченко Г.А., Дедов И.И. Проект клинических рекомендаций по гипотиреозу. Клиническая и экспериментальная тиреоидология. 2021;17(1):4-13 [Fadeev VV, Morgunova TB, Melnichenko GA, Dedov II. Draft of the clinical recommendations for diagnosis and treatment of hypothyroidism. Clinical and Experimental Thyroidology. 2021;17(1):4-13 (in Russian)]. DOI:10.14341/ket12702
19. Park S, Jeon MJ, Song E, et al. Clinical features of early and late postoperative hypothyroidism after lobectomy. J Clin Endocrinol Metab. 2017;102(4):1317-24. DOI:10.1210/jc.2016-3597
20. Verloop H, Louwerens M, Schoones JW, et al. Risk of hypothyroidism following hemithyroidectomy: Systematic review and meta-analysis of prognostic studies. J Clin Endocrinol Metab. 2012;97(7):2243-55. DOI:10.1210/jc.2012-1063
21. Цыб А.Ф., Матвеенко Е.Г., Нестайко Г.В., Горобец В.Ф. Пострадиационный гипотиреоз (научный обзор). Радиация и риск. 1997;10:61-83 [Tsyb AF, Matveenko EG, Nestaiko GB, Gorobets VF. Radiation associated hypothyroidism (Scientific review). Radiation and Risk. 1997;10:61-83 (in Russian)].
22. Reiners C, Drozd V, Yamashita S. Hypothyroidism after radiation exposure: Brief narrative review. J Neural Transm (Vienna). 2020;9;127(11):1455-66. DOI:10.1007/s00 702-020-02260-5
23. Grunenwald S, Caron P. Central hypothyroidism in adults: Better understanding for better care. Pituitary. 2015;18(1):169-75. DOI:10.1007/s11102-014-0559-8
24. Persani L. Clinical review: Central hypothyroidism: Pathogenic, diagnostic, and therapeutic challenges. J Clin Endocrinol Metab. 2012;97(9):3068-78. DOI:10.1210/jc.2012-1616
25. Zhipeng W, Hongsen W, Chen B. Tyrosine kinase inhibitor-induced hypothyroidism: Mechanism and clinical implications. Eur J Clin Pharmacol. 2024;80(6):827-38. DOI:10.1007/s00228-024-03626-4
26. Laurberg P, Andersen S, Bülow Pedersen I, Carlé A. Hypothyroidism in the elderly: Pathophysiology, diagnosis and treatment. Drugs Aging. 2005;22(1):23-38. DOI:10.2165/00002512-200522010-00002
27. Zhong B, Wang Y, Zhang G, Wang Z. Environmental iodine content, female sex and age are associated with new-onset amiodarone-induced hypothyroidism: A systematic review and meta-analysis of adverse reactions of amiodarone on the thyroid. Cardiology. 2016;134(3):366-71. DOI:10.1159/000444578
28. Burch HB. Drugs affecting thyroid function. N Engl J Med. 2019;381(8):749-61. DOI:10.1056/NEJMra1901214
29. Rizzo LFL, Mana DL, Serra HA. Drug-induced hypothyroidism. Medicina (B Aires). 2017;77(5):394-404. PMID:29044016
30. Philippou G, Koutras DA, Piperingos G, et al. The effect of iodide on serum thyroid hormone levels in normal persons, in hyperthyroid patients, and in hypothyroid patients on thyroxine replacement. Clin Endocrinol (Oxf). 1992;36(6):573-8. DOI:10.1111/j.1365-2265.1992.tb02267
31. Lee SY, Rhee CM, Leung AM, et al. A review: Radiographic iodinated contrast-induced thyroid dysfunction. J Clin Endocrinol Metab. 2015;100(2):376-83. DOI:10.1210/jc.2014-3292
32. Kornelius E, Chiou JY, Yang YS, et al. Iodinated contrast media increased the risk of thyroid dysfunction: A 6-year retrospective cohort study. J Clin Endocrinol Metab. 2015;100(9):3372-9. DOI:10.1210/jc.2015-2329
33. Bartalena L, Bogazzi F, Chiovato C. 2018 European Thyroid Association (ETA) Guidelines for the management of amiodarone-associated thyroid dysfunction. Eur Thyroid J. 2018;7(2):55-66. DOI:10.1159/000486957
34. Cooper DS. Antithyroid drugs. N Engl J Med. 2005;352(9):905-17. DOI:10.1056/nejmra042972
35. Глибка А.А., Мазурина Н.В., Саранцева К.А., и др. Заболевания щитовидной железы, развивающиеся на фоне терапии злокачественных опухолей ингибиторами контрольных точек иммунного ответа. Альманах клинической медицины. 2022;50(3);187-95 [Glibka AA, Mazurina NV, Sarantseva KA, et al. Thyroid disorders induced by immune checkpoint inhibitors therapy of malignant tumors. Almanac of Clinical Medicine. 2022;50(3):187-95 (in Russian)]. DOI:10.18786/2072-0505-2022-50-020
36. Жеребчикова К.Ю., Сыч Ю.П., Амосова М.В., и др. Эндокринологические нежелательные явления на фоне терапии ингибиторами контрольных точек у пациентов со злокачественными новообразованиями. РМЖ. Медицинское обозрение. 2022;6(9):528-33 [Zherebchikova KYu, Sych YuP, Amosova MV, et al. Endocrine adverse events in patients with malignant neoplasms receiving treatment with immune checkpoint inhibitors. Russian Medical Inquiry. 2022;6(9):528-33 (in Russian)]. DOI:10.32364/2587-6821-2022-6-9-528-533
37. Boelaert K. Thyroid dysfunction in the elderly. Nature Rev Endocrinol. 2013;9(4):194-204. DOI:10.1038/nrendo.2013.30
38. Hall R, Scanlon MF. Hypothyroidism: Clinical features and complications. Clin Endocrinol Metab. 1979;8(1):29-38. DOI:10.1016/s0300-595x(79)80007-9
39. Carlé A, Pedersen IB, Knudsen N, et al. Hypothyroid symptoms fail to predict thyroid insufficiency in old people: A population-based case-control study. Am J Med. 2016;129(10):1082-92. DOI:10.1016/j.amjmed.2016.06.013
40. Grais IM, Sowers JR. Thyroid and the heart. Am J Med. 2014;127(8):691-8. DOI:10.1016/j.amjmed.2014.03.009
41. Faber J, Selmer C. Cardiovascular disease and thyroid function. Front Horm Res. 2014;43:45-56. DOI:10.1159/000360558
42. Hernando VU, Eliana MS. Role of thyroid hormones in different aspects of cardiovascular system. Endocrinol Metab Synd. 2015;4(2):166. DOI:10.4172/2161-1017.1000166
43. Artantaş S, Gül U, Kiliç A, Güler S. Skin findings in thyroid diseases. Eur J Intern Med. 2009;209(2):158-61. DOI:10.1016/j.ejim.2007.09.021
44. Udovcic M, Pena RH, Patham B, et al. Hypothyroidism and the Heart. Methodist Debakey Cardiovasc J. 2017;13(2):55-9. DOI:10.14797/mdcj-13-2-55
45. Lu S, Guan Q, Liu Y, et al. Role of extrathyroidal TSHR expression in adipocyte differentiation and its association with obesity. Lipids Health Dis. 2012;11:17. DOI:10.1186/1476-511x-11-17
46. Kim B. Thyroid hormone as a determinant of energy expenditure and the basal metabolic rate. Thyroid. 2008;18(2):141-4. DOI:10.1089/thy.2007.0266
47. Grunstein RR, Sullivan CE. Sleep apnea and hypothyroidism: Mechanisms and management. Am J Med. 1988;85(6):775-9. DOI:10.1016/s0002-9343(88)80020-2
48. de Carvalho GA, Fighera TM. Effect of gastrointestinal disorders in autoimmune thyroid diseases. Transl Gastrointest Cancer. 2015;4(1):76-82.
49. Rhee CK. The interaction between thyroid and kidney disease: An overview of the evidence. Curr Opin Endocrinol Diabetes Obes. 2016;23(5):407-15. DOI:10.1097/MED.0000000000000275
50. De Sousa A, Shrivastava A. Neurocognition and hypothyroidism: Critical points. Ann Indian Psychiatry. 2017;1(2):118-9. DOI:10.4103/aip.aip_26_17
51. Есина М.М. Система репродукции при гипотиреозе. Архив акушерства и гинекологии им. В.Ф. Снегирева. 2017;4(2):77-83 [Esina MM. System of reproduction in hypothyreosis. V.F. Snegirev Archives of Obstetrics and Gynecology, Russian journal. 2017;4(2):77-83 (in Russian)]. DOI:10.18821/2313-8726-2017-4-2-77-83
52. Honbo KS, van Herle AJ, Kellett KA. Serum prolactin levels in untreated primary hypothyroidism. Am J Med. 1978;64(5):782-7. DOI:10.1016/0002-9343(78)90517-x
53. Ben-Jonathan N, Hnasko R. Dopamine as a prolactin inhibitor. Endocrine Rewiews. 2001;22(6):724-63. DOI:10.1210/edrv.22.6.0451
54. Collins AB, Pawlak R. Prevalence of vitamin B-12 deficiency among patients with thyroid dysfunction. Asia Pac J Clin Nutr. 2016;25(2):221-6. DOI:10.6133/apjcn.2016. 25.2.22
55. Yamada M, Mori M. Mechanisms related to the pathophysiology and management of central hypothyroidism. Nat Clin Pract Endocrinol Metab. 2008;4(12):683-94. DOI:10.1038/ncpendmet0995
56. O'Leary PC, Feddema PH, Michelangeli VP, et al. Investigations of thyroid hormones and anti-bodies based on a community health survey: The Busselton thyroid study. Clin Endocrinol. 2006;64(1):97-104. DOI:10.1111/j.1365-2265.2005.02424.x
57. Joshi AS, Woolf PD. Pituitary hyperplasia secondary to primary hypothyroidism: A case report and review of the literature. Pituitary. 2005;8(2):99-103. DOI:10.1007/s11102-005-3281-8
58. Clarke N, Kabadi UM. Optimizing treatment of hypothyroidism. Treat Endocrinol. 2004;3(4):217-21. DOI:10.2165/00024677-200403040-00003
59. Hueston WJ. Treatment of hypothyroidism. Am Fam Physician. 2001;64(10):1717-24. PMID:11759078
60. 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
61. Gaitonde DY, Rowley KD, Sweeney LB. Hypothyroidism: An update. Am Fam Physician. 2012;86(3):244-51. PMID:22962987
62. Virili C, Antonelli A, Santaguida MG, et al. Gastrointestinal malabsorption of thyroxine. Endocrine Reviews. 2019;40(1):118-36. DOI:10.1210/er.2018-00168
63. McMillan M, Rotenberg KS, Vora K. Comorbidities, concomitant medications, and diet as factors affecting levothyroxine therapy: Results of the CONTROL surveillance project. Drugs R D. 2016;16:53-68. DOI:10.1007/s40268-015-0116-6
64. Lahner E, Virili C, Santaguida MG, et al. Helicobacter pylori infection and drugs malabsorption. World J Gastroenterol. 2014;20(30):10331-7. DOI:10.3748/wjg.v20.i30.10331
65. Barbesino G. Drugs affecting thyroid function. Thyroid. 2010;20(7):763-70. DOI:10.1089/thy.2010.1635
66. Arafah BM. Increased need for thyroxine in women with hypothyroidism during es
________________________________________________
2. Taylor PN, Medici MM, Hubalewska-Dydejczyk A, Boelaert K. Hypothyroidism. Lancet. 2024;404(10460):1347-64. DOI:10.1016/S0140-6736(24)01614-3
3. Reznik EV, Godilo-Godlevsky VA, Zaynullina YI, et al. The dramatic outcome of the late diagnosis of the chronic autoimmune thyroiditis with the severe primary hypothyroidism. The Russian Archives of Internal Medicine. 2023;13(2):144-54 (in Russian). DOI:10.20514/2226-6704-2023-13-2-144-154
4. Lindholm J, Laurberg P. Hypothyroidism and thyroid substitution: Historical aspects. J Thyroid Res. 2011;2011:1-10. DOI:10.4061/2011/809341
5. Chaker L, Bianco AC, Jonklaas J, Peeters RP. Hypothyroidism. Lancet. 2017;390(1010 1):1550-62. DOI:10.1016/S0140-6736(17)30703-1
6. Hegedüs L, Bianco AC, Jonklaas J, et al. Primary hypothyroidism and quality of life. Nat Rev Endocrinol. 2022;18(4):230-42. DOI:10.1038/s41574-021-00625-8
7. Feldt-Rasmussen U, Effraimidis G, Bliddal S, Klose M. Consequences of undertreatment of hypothyroidism. Endocrine. 2024;84(2):301-8. DOI:10.1007/s12020-023-03460-1
8. Taylor PN, Iqbal A, Minassian C, et al. Falling threshold for treatment of borderline elevated thyrotropin levels-balancing benefits and risks: Evidence from a large community-based study. JAMA Intern Med. 2014;174(1):32-9. DOI:0.1001/jamainternmed.20 13.11312
9. Manuylova YuA, Morgunova TB, Fadeyev VV. Causes of treatment failure in primary hypothyroidism. Clinical and Experimental Thyroidology. 2019;15(1):12-8 (in Russian). DOI:10.14341/ket10163
10. Roberts CG, Ladenson PW. Hypothyroidism. Lancet. 2004;363(9411):793-803. DOI:10.1016/s0140-6736(04)15696-1
11. Aoki Y, Belin RM, Clickner R, et al. Serum TSH and total T4 in the United States population and their association with participant characteristics: National Health and Nutrition Examination Survey (NHANES 1999–2002). Thyroid. 2007;17(12):1211-23. DOI:10.1089/thy.2006.0235
12. Garmendia Madariaga A, Santos Palacios S, Guillén-Grima F, Galofré JC. The incidence and prevalence of thyroid dysfunction in Europe: A meta-analysis. J Clin Endocrinol Metab. 2014;99(3):923-31. DOI:10.1210/jc.2013-2409
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Авторы
Е.В. Бирюкова*, А.Д. Абрамова
ФГБОУ ВО «Российский университет медицины» Минздрава России, Москва, Россия
*lena@obsudim.ru
Russian University of Medicine, Moscow, Russia
*lena@obsudim.ru
ФГБОУ ВО «Российский университет медицины» Минздрава России, Москва, Россия
*lena@obsudim.ru
________________________________________________
Russian University of Medicine, Moscow, Russia
*lena@obsudim.ru
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