Cиндром тиреотоксикоза. Дифференциальная диагностика и лечение
Cиндром тиреотоксикоза. Дифференциальная диагностика и лечение
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Аннотация
Начиная с середины ХХ в. происходит существенное изменение подходов к диагностике и лечению заболеваний щитовидной железы (ЩЖ), протекающих с синдромом тиреотоксикоза. Если еще в недавнем прошлом врачи не испытывали затруднений лишь с диагностикой заболеваний, протекающих с типичной клинической картиной (мерзебургская триада, многоузловой зоб с фибрилляцией) и сама возможность определения тиреоидных гормонов была недоступна, то появление иммунологических методов оценки гормонов в крови в начале 70-х годов ХХ в. привело к существенным изменениям нашего понимания вариантов патологии ЩЖ, протекающих с превалирующим вкладом тиреотоксикоза (ТТ). Сегодня диагностика факта ТТ в целом не представляет затруднений (сумятицу вносят разве что преаналитические ошибки), но дифференциальная диагностика в рамках заявленного синдрома остается крайне актуальной по сей день. К сожалению, в сознании многих врачей эти заболевания порой воспринимаются как некое целое, а в условиях «века скоростей» современный доктор, крайне ограниченный во времени, нередко при выявлении тиреотоксикоза неоправданно назначает тиреостатическую терапию, лечение радиоактивным йодом или даже оперативное вмешательство. Старая истина: «Помните, что больной с тиреотоксикозом – это человек с больным сердцем…» – не утратила актуальности по сей день. Учитывая важность влияния избытка тиреоидных гормонов на сердечно-сосудистую систему и систему гемостаза, для практикующего врача имеет принципиальное значение способность ориентироваться в спектре патологий, проявляющихся клинической картиной тиреотоксикоза. В свете вышеизложенного в статье мы постарались отразить аспекты диагностической тактики с акцентом на дифференциальные различия патологий с синдромом ТТ, которым проявляется немалый спектр заболеваний ЩЖ и даже внетироидальные заболевания.
Ключевые слова: щитовидная железа, тиреотоксикоз, гипертиреоз, болезнь Грейвса, многоузловой токсический зоб.
Keywords: thyroid, thyrotoxicosis, hyperthyroidism, Graves’ disease, toxic multinodular goiter.
Ключевые слова: щитовидная железа, тиреотоксикоз, гипертиреоз, болезнь Грейвса, многоузловой токсический зоб.
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Keywords: thyroid, thyrotoxicosis, hyperthyroidism, Graves’ disease, toxic multinodular goiter.
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19. Доступно по ссылке: http://www.hgmd.cf.ac.uk
20. Weetman AP. Autoimmune thyroid disease: propagation and progression. Eur J Endocrinol. 2003 Jan;148(1):1-9. doi:10.1530/eje.0.1480001
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25. Barbesino G, Tomer Y. Clinical Utility of TSH Receptor Antibodies. J Clin Endocrinol Metab. 2013;98(6):2247-2255. doi: 10.1210/jc.2012-4309
26. Hansen PS, Brix TH, Iachine I, Kyvik KO, Hegedüs L. The relative importance of geneticand environmental effects for the early stages of thyroid autoimmunity: a study of healthy Danish twins. Eur J Endocrinol. 2006 Jan;154(1):29-38. doi: 10.1530/eje.1.02060
27. Hasham A, Tomer Y. Genetic and epigenetic mechanisms in thyroid autoimmunity. Immunol Res. 2012;54(1-3):204-213. doi: 10.1007/s12026-012-8302-x
28. Liyanage CK, Munasinghe TMJ, Paramanantham A. Steroid-Responsive Encephalopathy Associated with Autoimmune Thyroiditis Presenting with Fever and Confusion. Case Rep Neurol Med. 2017;2017:1-4. doi: 10.1155/2017/3790741
29. Bartalena L. Diagnosis and management of Graves disease: a global overview. Nat Rev Endocrinol. 2013;9(12):724-734. doi: 10.1038/nrendo.2013.193
30. Keely EJ. Postpartum thyroiditis: an autoimmune thyroid disorder which predicts future thyroid health. Obstet Med. 2011;4(1):7-11. doi: 10.1258/om.2010.100041
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35. Rao RH, McCready VR, Spathis GS. Iodine kinetic studies during amiodarone treatment. J Clin Endocrinol Metab. 1986 Mar;62(3):563-568. doi: 10.1210/jcem-62-3-563
36. Bogazzi F, Martino E, Dell’Unto E, et al. Thyroid color flow doppler sonography and radioiodine uptake in 55 consecutive patients with amiodarone-induced thyrotoxicosis. J Endocrinol Invest. 2003;26(7):635-640. doi: 10.1007/BF03347021
37. Ordookhani A, Burman KD. Hemostasis in Overt and Subclinical Hyperthyroidism. Int J Endocrinol Metab. 2017;15(3):e44157. doi: 10.5812/ijem.44157
38. Maseeh-uz-Zaman, Fatima N, Sajjad Z. Amiodarone therapy: don’t forget thyroid. JPMA J Pak Med Assoc. 2012 Mar;62(3):268-272.
39. Свириденко Н.Ю., Молашенко Н.В., Платонова Н.М., Атаманова Т.М., Сердюк С.Е., Бакалов С.А., Голицин С.П. Функциональное состояние щитовидной железы у пациентов, принимающих амиодарон. Методы коррекции тиреоидной дисфункции. Клиническая тиреоидология. 2004;2(4):19-26 [Sviridenko NYu, Molashenko NV, Platonova NM, Atamanova TM, Serdyuk SE, Bakalov SA, Golitsin SP. Functional state of the thyroid gland in patients taking amiodarone. Methods of correcting thyroid dysfunction. Klinicheskaya Tireoidologiya = Clinical Thyroidology. 2004;2(4):19-26 (In Russ.)].
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41. Brooks MJ, Pattison DA, Teo EP, Price S, Gurvitch R. Amiodarone-Induced Destructive Thyroiditis Associated with Coronary Artery Vasospasm and Recurrent Ventricular Fibrillation. Eur Thyroid J. 2013;2:65-66. doi: 10.1159/000345528
42. Parmar MS, Sturge C. Recurrent hamburger thyrotoxicosis. CMAJ. 2003 Sep 2;169(5):415-417.
43. Hendriks LEL, Looij BJ. Hyperthyroidism caused by excessive consumption of sausages. Neth J Med. 2010 Mar;68(3):135-137.
44. Megias MC, Iglesias P, Villanueva MG, Diez JJ. Intermittent and recurrent episodes of subclinical hypothyroidism, central hypothyroidism and T3-toxicosis in an elderly woman.
Case Reports. 2012;2012(aug14 2):bcr2012006260-bcr2012006260. doi: 10.1136/bcr-2012-006260
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46. Beck-Peccoz P, Lania A, Beckers A, Chatterjee K, Wemeau J-L. 2013 European Thyroid Association Guidelines for the Diagnosis and Treatment of Thyrotropin-Secreting Pituitary Tumors. Eur Thyroid J. 2013;2(2):76-82. doi: 10.1159/000351007
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49. Refetoff S. Resistance to thyroid hormone with and without receptor gene mutations. Ann Endocrinol (Paris). 2003 Feb;64(1):23-25.
50. Safer JD, Cohen RN, Hollenberg AN, et al. Defective release of corepressor by hinge mutants of the thyroid hormone receptor found in patients with resistance to thyroid hormone. J Biol Chem. 1998 Nov 13;273(46):30175-30182. doi: 10.1074/jbc.273.46.30175
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54. Beck-Peccoz P, Persani L. TSH-induced hyperthyroidism caused by a pituitary tumor. Nat Clin Pract Endocrinol Metab. 2006 Sep;2(9):524-528; quiz following p528.
55. Okuno S, Inaba M, Kitatani K, Ishimura E, Yamakawa T, Nishizawa Y. Serum levels of C-terminal telopeptide of type I collagen: a useful new marker of cortical bone loss in hemodialysis patients. Osteoporos Int. 2005;16(5):501-509. doi: 10.1007/s00198-004-1712-4
56. Chatterjee VKK. Resistance to Thyroid Hormone. Horm Res. 1997;48(4):43-46. doi: 10.1159/000191312
Авторы
Г.А. Мельниченко, И.И. Ларина
ФГБУ «Медицинский исследовательский центр эндокринологии» Минздрава России, Москва, Россия
Medical Research Center of Endocrinology, Ministry of Health of Russia, Moscow, Russia
ФГБУ «Медицинский исследовательский центр эндокринологии» Минздрава России, Москва, Россия
________________________________________________
Medical Research Center of Endocrinology, Ministry of Health of Russia, Moscow, Russia
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