Центральный гипотиреоз - Журнал Терапевтический архив № 10 Вопросы эндокринологии 2019
Центральный гипотиреоз
Петунина Н.А., Трухина Л.В., Мартиросян Н.С. Центральный гипотиреоз: современные представления о диагностике и лечении. Терапевтический архив. 2019; 91 (10): 135–138. DOI: 10.26442/00403660.2019.10.000358
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Аннотация
Центральный гипотиреоз является редкой формой гипотиреоза, обусловленной поражением гипофиза (вторичный гипотиреоз) или гипоталамуса (третичный гипотиреоз). Затруднения в диагностике и ведении больных обусловлены стертой клинической картиной, частым сочетанием с нарушениями функции других тропных гормонов гипофиза, трудностями лабораторной верификации диагноза при высоком уровне тиреотропного гормона (ТТГ) и низком или нормальном уровне свободного Т4. Диагностика основывается на подтвержденном снижении уровня свободного Т4 при низком или нормальном уровне ТТГ. Стандартом лечения гипотиреоза любой этиологии при этом остается монотерапия левотироксином натрия, позволяющая восстановить эутиреоидное состояние у большинства пациентов. Критерием эффективности терапии является поддержание уровня свободного Т4 в верхней половине референсного интервала нормы. В статье приведены современные представления об эпидемиологии, патогенезе и стратегии ведения пациентов с центральным гипотиреозом.
Ключевые слова: центральный гипотиреоз, гипопитуитаризм, L-тироксин.
Keywords: central hypothyroidism, hypopituitarism, L-thyroxine.
Ключевые слова: центральный гипотиреоз, гипопитуитаризм, L-тироксин.
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Keywords: central hypothyroidism, hypopituitarism, L-thyroxine.
Список литературы
1. Lania A, Persani L, Beck-Peccoz P. Central hypothyroidism. Pituitary. 2008;11(2):181-6. doi: 10.1007/s11102-008-0122-6
2. Persani L, Brabant G, Dattani M, Bonomi M, Feldt-Rasmussen U, Fliers E, Gruters A, Maiter D, Schoenmakers N, van Trotsenburg ASP. 2018 European Thyroid Association (ETA) Guidelines on the Diagnosis and Management of Central Hypothyroidism. Eur Thyroid J. 2018;7:225-37. doi: 10.1159/000491388
3. Beck-Peccoz P, Rodari G, Giavoli C, Lania A. Central hypothyroidism – a neglected thyroid disorder. Nat Rev Endocrinol. 2017;Oct;13(10):588-98. doi: 10.1038/nrendo.2017.47
4. Heinen CA, Losekoot M, Sun Y, Watson PJ, Fairall L, Joustra SD, Zwaveling-Soonawala N, Oostdijk W, van den Akker EL, Alders M, Santen GW, van Rijn RR, Dreschler WA, Surovtseva OV, Biermasz NR, Hennekam RC, Wit JM, Schwabe JW, Boelen A, Fliers E, van Trotsenburg AS. Mutations in TBL1X are associated with central hypothyroidism. J Clin Endocrinol Metab. 2016;101:4564-73. doi: 10.1210/jc.2016-2531
5. Faglia G, Bitensky L, Pinchera A, Ferrari C, Paracchi A, Beck-Peccoz P, Ambrosi B, Spada A. Thyrotropin secretion in patients with central hypothyroidism: evidence for reduced biological activity of immunoreactive thyrotropin. J Clin Endocrinol Metab. 1979;48:989-98.
6. García M, González de Buitrago J, Jiménez-Rosés M, Pardo L, Hinkle PM, Moreno JC. Central Hypothyroidism Due to a TRHR Mutation Causing Impaired Ligand Affinity and Transactivation of Gq. J Clin Endocrinol Metab. 2017 Jul 1;102(7):2433-42. doi: 10.1210/jc.2016-3977
7. Persani L. Clinical review: Central hypothyroidism: pathogenic, diagnostic, and therapeutic challenges. J Clin Endocrinol Metab. 2012 Sep;97(9):3068-78. doi: 10.1210/jc.2012-1616
8. Haugen BR. Drugs that suppress TSH or cause central hypothyroidism. Best Pract Res Clin Endocrinol Metab. 2009 Dec;23(6):793-800. doi: 10.1016/j.beem.2009.08.003
9. Russo M, Scollo C, Pellegriti G, Cotta OR, Squatrito S, Frasca F, Cannavò S, Gullo D. Mitotane treatment in patients with adrenocortical cancer causes central hypothyroidism. Clin Endocrinol (Oxf). 2016 Apr;84(4):614-9. doi: 10.1111/cen.12868
10. Alexopoulou O, Beguin C, De Nayer P, Maiter D. Clinical and hormonal characteristics of central hypothyroidism at diagnosis and during follow-up in adult patients. Eur J Endocrinol. 2004 Jan;150(1):1-8.
11. Slawik M, Klawitter B, Meiser E, Schories M, Zwermann O, Borm K, Peper M, Lubrich B, Hug MJ, Nauck M, Olschewski M, Beuschlein F, Reincke M. Thyroid hormone replacement for central hypothyroidism: a randomized controlled trial comparing two doses of thyroxine (T4) with a combination of T4 and triiodothyronine. J Clin Endocrinol Metab. 2007 Nov;92(11):4115-22.
12. Jonklaas J. Update on the treatment of hypothyroidism. Curr Opin Oncol. 2016 Jan;28(1):18-25. doi: 10.1097/CCO.0000000000000242
13. Rajput R, Chatterjee S, Rajput M. Can levothyroxine be taken as evening dose? Comparative evaluation of morning versus evening dose of levothyroxine in treatment of hypothyroidism. J Thyroid Res. 2011;2011:505239.
14. Bensenor IM, Olmos RD, Lotufo PA. Hypothyroidism in the elderly: diagnosis and management. Clin Interv Aging. 2012;7:97-111.
15. Koulouri O, Auldin MA, Agarwal R, Kieffer V, Robertson C, Falconer Smith J, Levy MJ, Howlett TA. Diagnosis and treatment of hypothyroidism in TSH deficiency compared to primary thyroid disease: pituitary patients are at risk of under-replacement with levothyroxine. Clin Endocrinol. 2011;74:744-9.
16. Hirata Y, Fukuoka H, Iguchi G, Iwahashi Y, Fujita Y, Hari Y, Iga M, Nakajima S, Nishimoto Y, Mukai M, Hirota Y, Sakaguchi K, Ogawa W, Takahashi Y. Median-lower normal levels of serum thyroxine are associated with low triiodothyronine levels and body temperature in patients with central hypothyroidism. Eur J Endocrinol. 2015;173:247-56. doi: 10.1530/EJE-15-0130
2. Persani L, Brabant G, Dattani M, Bonomi M, Feldt-Rasmussen U, Fliers E, Gruters A, Maiter D, Schoenmakers N, van Trotsenburg ASP. 2018 European Thyroid Association (ETA) Guidelines on the Diagnosis and Management of Central Hypothyroidism. Eur Thyroid J. 2018;7:225-37. doi: 10.1159/000491388
3. Beck-Peccoz P, Rodari G, Giavoli C, Lania A. Central hypothyroidism – a neglected thyroid disorder. Nat Rev Endocrinol. 2017;Oct;13(10):588-98. doi: 10.1038/nrendo.2017.47
4. Heinen CA, Losekoot M, Sun Y, Watson PJ, Fairall L, Joustra SD, Zwaveling-Soonawala N, Oostdijk W, van den Akker EL, Alders M, Santen GW, van Rijn RR, Dreschler WA, Surovtseva OV, Biermasz NR, Hennekam RC, Wit JM, Schwabe JW, Boelen A, Fliers E, van Trotsenburg AS. Mutations in TBL1X are associated with central hypothyroidism. J Clin Endocrinol Metab. 2016;101:4564-73. doi: 10.1210/jc.2016-2531
5. Faglia G, Bitensky L, Pinchera A, Ferrari C, Paracchi A, Beck-Peccoz P, Ambrosi B, Spada A. Thyrotropin secretion in patients with central hypothyroidism: evidence for reduced biological activity of immunoreactive thyrotropin. J Clin Endocrinol Metab. 1979;48:989-98.
6. García M, González de Buitrago J, Jiménez-Rosés M, Pardo L, Hinkle PM, Moreno JC. Central Hypothyroidism Due to a TRHR Mutation Causing Impaired Ligand Affinity and Transactivation of Gq. J Clin Endocrinol Metab. 2017 Jul 1;102(7):2433-42. doi: 10.1210/jc.2016-3977
7. Persani L. Clinical review: Central hypothyroidism: pathogenic, diagnostic, and therapeutic challenges. J Clin Endocrinol Metab. 2012 Sep;97(9):3068-78. doi: 10.1210/jc.2012-1616
8. Haugen BR. Drugs that suppress TSH or cause central hypothyroidism. Best Pract Res Clin Endocrinol Metab. 2009 Dec;23(6):793-800. doi: 10.1016/j.beem.2009.08.003
9. Russo M, Scollo C, Pellegriti G, Cotta OR, Squatrito S, Frasca F, Cannavò S, Gullo D. Mitotane treatment in patients with adrenocortical cancer causes central hypothyroidism. Clin Endocrinol (Oxf). 2016 Apr;84(4):614-9. doi: 10.1111/cen.12868
10. Alexopoulou O, Beguin C, De Nayer P, Maiter D. Clinical and hormonal characteristics of central hypothyroidism at diagnosis and during follow-up in adult patients. Eur J Endocrinol. 2004 Jan;150(1):1-8.
11. Slawik M, Klawitter B, Meiser E, Schories M, Zwermann O, Borm K, Peper M, Lubrich B, Hug MJ, Nauck M, Olschewski M, Beuschlein F, Reincke M. Thyroid hormone replacement for central hypothyroidism: a randomized controlled trial comparing two doses of thyroxine (T4) with a combination of T4 and triiodothyronine. J Clin Endocrinol Metab. 2007 Nov;92(11):4115-22.
12. Jonklaas J. Update on the treatment of hypothyroidism. Curr Opin Oncol. 2016 Jan;28(1):18-25. doi: 10.1097/CCO.0000000000000242
13. Rajput R, Chatterjee S, Rajput M. Can levothyroxine be taken as evening dose? Comparative evaluation of morning versus evening dose of levothyroxine in treatment of hypothyroidism. J Thyroid Res. 2011;2011:505239.
14. Bensenor IM, Olmos RD, Lotufo PA. Hypothyroidism in the elderly: diagnosis and management. Clin Interv Aging. 2012;7:97-111.
15. Koulouri O, Auldin MA, Agarwal R, Kieffer V, Robertson C, Falconer Smith J, Levy MJ, Howlett TA. Diagnosis and treatment of hypothyroidism in TSH deficiency compared to primary thyroid disease: pituitary patients are at risk of under-replacement with levothyroxine. Clin Endocrinol. 2011;74:744-9.
16. Hirata Y, Fukuoka H, Iguchi G, Iwahashi Y, Fujita Y, Hari Y, Iga M, Nakajima S, Nishimoto Y, Mukai M, Hirota Y, Sakaguchi K, Ogawa W, Takahashi Y. Median-lower normal levels of serum thyroxine are associated with low triiodothyronine levels and body temperature in patients with central hypothyroidism. Eur J Endocrinol. 2015;173:247-56. doi: 10.1530/EJE-15-0130
2. Persani L, Brabant G, Dattani M, Bonomi M, Feldt-Rasmussen U, Fliers E, Gruters A, Maiter D, Schoenmakers N, van Trotsenburg ASP. 2018 European Thyroid Association (ETA) Guidelines on the Diagnosis and Management of Central Hypothyroidism. Eur Thyroid J. 2018;7:225-37. doi: 10.1159/000491388
3. Beck-Peccoz P, Rodari G, Giavoli C, Lania A. Central hypothyroidism – a neglected thyroid disorder. Nat Rev Endocrinol. 2017;Oct;13(10):588-98. doi: 10.1038/nrendo.2017.47
4. Heinen CA, Losekoot M, Sun Y, Watson PJ, Fairall L, Joustra SD, Zwaveling-Soonawala N, Oostdijk W, van den Akker EL, Alders M, Santen GW, van Rijn RR, Dreschler WA, Surovtseva OV, Biermasz NR, Hennekam RC, Wit JM, Schwabe JW, Boelen A, Fliers E, van Trotsenburg AS. Mutations in TBL1X are associated with central hypothyroidism. J Clin Endocrinol Metab. 2016;101:4564-73. doi: 10.1210/jc.2016-2531
5. Faglia G, Bitensky L, Pinchera A, Ferrari C, Paracchi A, Beck-Peccoz P, Ambrosi B, Spada A. Thyrotropin secretion in patients with central hypothyroidism: evidence for reduced biological activity of immunoreactive thyrotropin. J Clin Endocrinol Metab. 1979;48:989-98.
6. García M, González de Buitrago J, Jiménez-Rosés M, Pardo L, Hinkle PM, Moreno JC. Central Hypothyroidism Due to a TRHR Mutation Causing Impaired Ligand Affinity and Transactivation of Gq. J Clin Endocrinol Metab. 2017 Jul 1;102(7):2433-42. doi: 10.1210/jc.2016-3977
7. Persani L. Clinical review: Central hypothyroidism: pathogenic, diagnostic, and therapeutic challenges. J Clin Endocrinol Metab. 2012 Sep;97(9):3068-78. doi: 10.1210/jc.2012-1616
8. Haugen BR. Drugs that suppress TSH or cause central hypothyroidism. Best Pract Res Clin Endocrinol Metab. 2009 Dec;23(6):793-800. doi: 10.1016/j.beem.2009.08.003
9. Russo M, Scollo C, Pellegriti G, Cotta OR, Squatrito S, Frasca F, Cannavò S, Gullo D. Mitotane treatment in patients with adrenocortical cancer causes central hypothyroidism. Clin Endocrinol (Oxf). 2016 Apr;84(4):614-9. doi: 10.1111/cen.12868
10. Alexopoulou O, Beguin C, De Nayer P, Maiter D. Clinical and hormonal characteristics of central hypothyroidism at diagnosis and during follow-up in adult patients. Eur J Endocrinol. 2004 Jan;150(1):1-8.
11. Slawik M, Klawitter B, Meiser E, Schories M, Zwermann O, Borm K, Peper M, Lubrich B, Hug MJ, Nauck M, Olschewski M, Beuschlein F, Reincke M. Thyroid hormone replacement for central hypothyroidism: a randomized controlled trial comparing two doses of thyroxine (T4) with a combination of T4 and triiodothyronine. J Clin Endocrinol Metab. 2007 Nov;92(11):4115-22.
12. Jonklaas J. Update on the treatment of hypothyroidism. Curr Opin Oncol. 2016 Jan;28(1):18-25. doi: 10.1097/CCO.0000000000000242
13. Rajput R, Chatterjee S, Rajput M. Can levothyroxine be taken as evening dose? Comparative evaluation of morning versus evening dose of levothyroxine in treatment of hypothyroidism. J Thyroid Res. 2011;2011:505239.
14. Bensenor IM, Olmos RD, Lotufo PA. Hypothyroidism in the elderly: diagnosis and management. Clin Interv Aging. 2012;7:97-111.
15. Koulouri O, Auldin MA, Agarwal R, Kieffer V, Robertson C, Falconer Smith J, Levy MJ, Howlett TA. Diagnosis and treatment of hypothyroidism in TSH deficiency compared to primary thyroid disease: pituitary patients are at risk of under-replacement with levothyroxine. Clin Endocrinol. 2011;74:744-9.
16. Hirata Y, Fukuoka H, Iguchi G, Iwahashi Y, Fujita Y, Hari Y, Iga M, Nakajima S, Nishimoto Y, Mukai M, Hirota Y, Sakaguchi K, Ogawa W, Takahashi Y. Median-lower normal levels of serum thyroxine are associated with low triiodothyronine levels and body temperature in patients with central hypothyroidism. Eur J Endocrinol. 2015;173:247-56. doi: 10.1530/EJE-15-0130
________________________________________________
2. Persani L, Brabant G, Dattani M, Bonomi M, Feldt-Rasmussen U, Fliers E, Gruters A, Maiter D, Schoenmakers N, van Trotsenburg ASP. 2018 European Thyroid Association (ETA) Guidelines on the Diagnosis and Management of Central Hypothyroidism. Eur Thyroid J. 2018;7:225-37. doi: 10.1159/000491388
3. Beck-Peccoz P, Rodari G, Giavoli C, Lania A. Central hypothyroidism – a neglected thyroid disorder. Nat Rev Endocrinol. 2017;Oct;13(10):588-98. doi: 10.1038/nrendo.2017.47
4. Heinen CA, Losekoot M, Sun Y, Watson PJ, Fairall L, Joustra SD, Zwaveling-Soonawala N, Oostdijk W, van den Akker EL, Alders M, Santen GW, van Rijn RR, Dreschler WA, Surovtseva OV, Biermasz NR, Hennekam RC, Wit JM, Schwabe JW, Boelen A, Fliers E, van Trotsenburg AS. Mutations in TBL1X are associated with central hypothyroidism. J Clin Endocrinol Metab. 2016;101:4564-73. doi: 10.1210/jc.2016-2531
5. Faglia G, Bitensky L, Pinchera A, Ferrari C, Paracchi A, Beck-Peccoz P, Ambrosi B, Spada A. Thyrotropin secretion in patients with central hypothyroidism: evidence for reduced biological activity of immunoreactive thyrotropin. J Clin Endocrinol Metab. 1979;48:989-98.
6. García M, González de Buitrago J, Jiménez-Rosés M, Pardo L, Hinkle PM, Moreno JC. Central Hypothyroidism Due to a TRHR Mutation Causing Impaired Ligand Affinity and Transactivation of Gq. J Clin Endocrinol Metab. 2017 Jul 1;102(7):2433-42. doi: 10.1210/jc.2016-3977
7. Persani L. Clinical review: Central hypothyroidism: pathogenic, diagnostic, and therapeutic challenges. J Clin Endocrinol Metab. 2012 Sep;97(9):3068-78. doi: 10.1210/jc.2012-1616
8. Haugen BR. Drugs that suppress TSH or cause central hypothyroidism. Best Pract Res Clin Endocrinol Metab. 2009 Dec;23(6):793-800. doi: 10.1016/j.beem.2009.08.003
9. Russo M, Scollo C, Pellegriti G, Cotta OR, Squatrito S, Frasca F, Cannavò S, Gullo D. Mitotane treatment in patients with adrenocortical cancer causes central hypothyroidism. Clin Endocrinol (Oxf). 2016 Apr;84(4):614-9. doi: 10.1111/cen.12868
10. Alexopoulou O, Beguin C, De Nayer P, Maiter D. Clinical and hormonal characteristics of central hypothyroidism at diagnosis and during follow-up in adult patients. Eur J Endocrinol. 2004 Jan;150(1):1-8.
11. Slawik M, Klawitter B, Meiser E, Schories M, Zwermann O, Borm K, Peper M, Lubrich B, Hug MJ, Nauck M, Olschewski M, Beuschlein F, Reincke M. Thyroid hormone replacement for central hypothyroidism: a randomized controlled trial comparing two doses of thyroxine (T4) with a combination of T4 and triiodothyronine. J Clin Endocrinol Metab. 2007 Nov;92(11):4115-22.
12. Jonklaas J. Update on the treatment of hypothyroidism. Curr Opin Oncol. 2016 Jan;28(1):18-25. doi: 10.1097/CCO.0000000000000242
13. Rajput R, Chatterjee S, Rajput M. Can levothyroxine be taken as evening dose? Comparative evaluation of morning versus evening dose of levothyroxine in treatment of hypothyroidism. J Thyroid Res. 2011;2011:505239.
14. Bensenor IM, Olmos RD, Lotufo PA. Hypothyroidism in the elderly: diagnosis and management. Clin Interv Aging. 2012;7:97-111.
15. Koulouri O, Auldin MA, Agarwal R, Kieffer V, Robertson C, Falconer Smith J, Levy MJ, Howlett TA. Diagnosis and treatment of hypothyroidism in TSH deficiency compared to primary thyroid disease: pituitary patients are at risk of under-replacement with levothyroxine. Clin Endocrinol. 2011;74:744-9.
16. Hirata Y, Fukuoka H, Iguchi G, Iwahashi Y, Fujita Y, Hari Y, Iga M, Nakajima S, Nishimoto Y, Mukai M, Hirota Y, Sakaguchi K, Ogawa W, Takahashi Y. Median-lower normal levels of serum thyroxine are associated with low triiodothyronine levels and body temperature in patients with central hypothyroidism. Eur J Endocrinol. 2015;173:247-56. doi: 10.1530/EJE-15-0130
Авторы
Н.А. Петунина, Л.В. Трухина, Н.С. Мартиросян
ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский Университет), Москва, Россия
Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский Университет), Москва, Россия
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Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
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