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Srpski arhiv za celokupno lekarstvo
2003, vol. 131, br. 11-12, str. 467-473
jezik rada: srpski
vrsta rada: prikaz knjige

Supklinička tireoidna bolest -da li je lečiti, da li tragati za njom?
Univerzitet u Beogradu, Medicinski fakultet, Klinički centar Srbije

e-adresa: btrbojev@eunet.yu

Sažetak

Supklinički hipotireoidizam se definiše kao nalaz tireotropina iznad normalnih vredno-sti upotrebljene metode sa normalnim vrednostima tireoidnih hormona u krvi. Procenjena učestalost supkliničkog hipotireoidizma je 2,8% kod muškaraca i 7,8% kod žena, pri čemu učestalost raste s godinama. Između ostalih, faktori rizika za pojavu supkliničkog hipotireoidizma su nedostatak joda, dijabetes tip 1, Daunov sindrom i prisustvo tireoperoksidaza antitela. Mora se razlikovati od drugih stanja sa povišenim vrednostima tireostimulišućeg hormona (TSH), naročito od rezistencije na tireoidne hormone, interference sa heterofilnim anti-TSH antitelima, uticaja lekova (domperidon, metoklopramid) i netireoidnih bolesti. Tretman supkliničkog hipotireoidizma još nije definitivno procenjen; smatra se da treba oceniti faktore rizika, hiperlipidemiju i životno doba pre definitivne odluke o lečenju. Traganje za supkliničkim hipotireoidizmom danas je opravdano samo u populaciji žena koje su starije od 50 godina, kod trudnica i infertilnih parova. Supklinički hipertireoidizam se definiše kao vrednost TSH ispod 0,1 mU/l, uz normalne tireoidne hormone i bez primetnih kliničkih znakova hipermetabolizma. Ocenjena učestalost je od O,7 do 6,6% i veća je kod žena i starijih osoba. Uzroci mogu biti egzogeni, među kojima je najčešće jatrogeno prepisivanje neadekvatne doze levotireoksina. Endogena tireotoksikoza je najčešće posledica polinodoznetoksičnestrume ili solitarnogtoksičnog nodusa. Po-tencijalna opasnost od ovog stanja je poremećaj ritma srca (fibrilacija pretkomora) i razvoj srčane insufici-jencije. Pored toga, postoji opasnost od razvoja osteoporoze. Nema konsenzusa o terapiji. Egzogena supklinička tireotoksikoza može da se koriguje pažljivijom aplikacijom levotireoksina. Endogena se tretira radio jodom ili operativno, pošto se sa sigurnošću proceni da postoji neprihvatljiv rizik od poremećaja rada srca ili osteoporoze. Do sada nema konsenzusa o potrebi za aktivnim otkrivanjem supkliničkog hipertireoidizma.

Ključne reči

supklinička tireoidna bolest; hipertireoidizam; hipotireoidizam

Reference

Al-Abadi, A.C. (2001) Subclinical thyrotoxicosis. Postgrad Med J, 77(903): 29-32
al-Adsani H., Hoffer, L.J., Silva, J.E. (1997) Resting energy expenditure is sensitive to small dose changes in patients on chronic thyroid hormone replacement. J Clin Endocrinol Metab, 82(4): 1118-25
Allan, W.C., Haddow, J.E., Palomaki, G.E., Williams, J.R., Mitchell, M.L., Hermos, R.J., Faix, J.D., Klein, R.Z. (2000) Maternal thyroid deficiency and pregnancy complications: Implications for population screening. J Med Screen, 7(3): 127-30
Bastenie, P.A., Vanhaelst, L., Golstein, J., Smets, P. (1977) Asymptomatic autoimmune thyroiditis and coronary heart-disease. Cross-sectional and prospective studies. Lancet, 2(8030): 155-8
Bunevicius, R., Kazanavicius, G., Zalinkevicius, R., Prange, A.J. (1999) Effects of thyroxine as compared with thyroxine plus triiodothyronine in patients with hypothyroidism. N Engl J Med, 340(6): 424-9
Canaris, G.J., Manowitz, N.R., Mayor, G., Ridgway, E.C. (2000) The Colorado thyroid disease prevalence study. Arch Intern Med, 160(4): 526-34
Caron, P., Calazel, C., Parra, H.J., Hoff, M., Louvet, J.P. (1990) Decreased HDL cholesterol in subclinical hypothyroidism: The effect of L-thyroxine therapy. Clin Endocrinol (Oxf), 33(4): 519-23
Carr, D., McLeod, D.T., Parry, G., Thornes, H.M. (1988) Fine adjustment of thyroxine replacement dosage: Comparison of the thyrotrophin releasing hormone test using a sensitive thyrotrophin assay with measurement of free thyroid hormones and clinical assessment. Clin Endocrinol (Oxf), 28(3): 325-33
de Morreale, E.G., Obregon, M.J., del Escobar, R.F. (2000) Is neuropsychological development related to maternal hypothyroidism or to maternal hypothyroxinemia?. J Clin Endocrinol Metab, 85(11): 3975-87
Escobar-Morreale, H.F., del Rey, F.E., Obregon, M.J., de Escobar, G.M. (1996) Only the combined treatment with thyroxine and triiodothyronine ensures euthyroidism in all tissues of the thyroidectomized rat. Endocrinology, 137(6): 2490-502
Faber, J., Jensen, I.W., Petersen, L., Nygaard, B., Hegedus, L., Siersbaek-Nielsen, K. (1998) Normalization of serum thyrotrophin by means of radioiodine treatment in subclinical hyperthyroidism: Effect on bone loss in postmenopausal women. Clin Endocrinol (Oxf), 48(3): 285-90
Faber, J., Galloe, A.M. (1994) Changes in bone mass during prolonged subclinical hyperthyroidism due to L-thyroxine treatment: A meta-analysis. Eur J Endocrinol, 130(4): 350-6
Haggerty, J.J., Stern, R.A., Mason, G.A., Beckwith, J., Morey, C.E., Prange, A.J. (1993) Subclinical hypothyroidism: A modifiable risk factor for depression?. Am J Psychiatry, 150(3): 508-10
Hak, A.E., Pols, H.A., Visser, T.J., Drexhage, H.A., Hofman, A., Witteman, J.C. (2000) Subclinical hypothyroidism is an independent risk factor for atherosclerosis and myocardial infarction in elderly women: The Rotterdam Study. Ann Intern Med, 132(4): 270-8
Hamblin, P.S., Dyer, S.A., Mohr, V.S., le Grand, B.A., Lim, C.F., Tuxen, D.V., Topliss, D.J., Stockigt, J.R. (1986) Relationship between thyrotropin and thyroxine changes during recovery from severe hypothyroxinemia of critical illness. J Clin Endocrinol Metab, 62(4): 717-22
Helfand, M., Redfern, C.C. (1998) Clinical guideline, part 2: Screening for thyroid disease: An update, American College of Physicians. Ann Intern Med, 129(2): 144-58
Hollowell, J.G., Garbe, P.L., Miller, D.T. (1999) Maternal thyroid deficiency during pregnancy and subsequent neuropsychological development of the child. N Engl J Med, 341(26): 2016-7
Klein, Irwin. (2000) Cardiovascular effects of hyperthyroidism. UpToDate, electronic edition
Laurberg, P., Bulow, P.I., Knudsen, N., Ovesen, L., Andersen, S. (2001) Environmental iodine intake affects the type of nonmalignant thyroid disease. Thyroid, 11(5): 457-69
Laurberg, P., Nohr, S.B., Pedersen, K.M., Hreidarsson, A.B., Andersen, S., Bulow, P.I., Knudsen, N., Perrild, H., Jorgensen, T., Ovesen, L. (2000) Thyroid disorders in mild iodine deficiency. Thyroid, 10(11): 951-63
Marqusee, E., Haden, S.T., Utiger, R.D. (1998) Subclinical thyrotoxicosis. Endocrinol Metab Clin North Am, 27(1): 37-49
McDermott, M.T., Ridgway, E.C. (2001) Subclinical hypothyroidism is mild thyroid failure and should be treated. J Clin Endocrinol Metab, 86(10): 4585-90
Meier, C., Staub, J.J., Roth, C.B., Guglielmetti, M., Kunz, M., Miserez, A.R., Drewe, J., Huber, P., Herzog, R., Muller, B. (2001) TSH-controlled L-thyroxine therapy reduces cholesterol levels and clinical symptoms in subclinical hypothyroidism: A double blind, placebo-controlled trial (Basel Thyroid Study). J Clin Endocrinol Metab, 86(10): 4860-6
Mudde, A.H., Houben, A.J., Nieuwenhuijzen, K.A.C. (1994) Bone metabolism during anti-thyroid drug treatment of endogenous subclinical hyperthyroidism. Clin Endocrinol (Oxf), 41(4): 421-4
Nilsson, G., Nordlander, S., Levin, K. (1976) Studies on subclinical hypothyroidism with special reference to the serum lipid pattern. Acta Med Scand, 200(1-2): 63-67
Okayasu, I., Hara, Y., Nakamura, K., Rose, N.R. (1994) Racial and age-related differences in incidence and severity of focal autoimmune thyroiditis. Am J Clin Pathol, 101(6): 698-702
Owen, P.J.D., Lazarus, J.H. (2003) Subclinical hypothyroidism: The case for treatment. Trends in Endocrinology and Metabolism, 14(6), 257-261
Parle, J.V., Franklyn, J.A., Cross, K.W., Jones, S.R., Sheppard, M.C. (1992) Circulating lipids and minor abnormalities of thyroid function. Clin Endocrinol (Oxf), 37(5): 411-4
Parle, J.V., Franklyn, J.A., Cross, K.W., Jones, S.C., Sheppard, M.C. (1991) Prevalence and follow-up of abnormal thyrotrophin (TSH) concentrations in the elderly in the United Kingdom. Clin Endocrinol (Oxf), 34(1): 77-83
Pinchera, A., Michele, M. (2002) Subclinical thyroid disease: To treat or not. u: Proc Internat Course in Thyroidology. Plovdiv, Bulgaria
Pop, V.J., Kuijpens, J.L., van Baar, A.L., Verkerk, G., van Son, M.M., de Vijlder, J.J., Vulsma, T., Wiersinga, W.M., Drexhage, H.A., Vader, H.L. (1999) Low maternal free thyroxine concentrations during early pregnancy are associated with impaired psychomotor development in infancy. Clin Endocrinol (Oxf), 50(2): 149-55
Ross, D.S. (1994) Hyperthyroidism, thyroid hormone therapy, and bone. Thyroid, 4(3): 319-26
Sawin, C.T., Geller, A., Wolf, P.A., Belanger, A.J., Baker, E., Bacharach, P., Wilson, P.W., Benjamin, E.J., D'Agostino, R.B. (1994) Low serum thyrotropin concentrations as a risk factor for atrial fibrillation in older persons. N Engl J Med, 331(19): 1249-52
Spencer, C., Eigen, A., Shen, D., Duda, M., Qualls, S., Weiss, S., Nicoloff, J. (1987) Specificity of sensitive assays of thyrotropin (TSH) used to screen for thyroid disease in hospitalized patients. Clin Chem, 33(8): 1391-6
Staub, J.J., Althaus, B.U., Engler, H., Ryff, A.S., Trabucco, P., Marquardt, K., Burckhardt, D., Girard, J., Weintraub, B.D. (1992) Spectrum of subclinical and overt hypothyroidism: Effect on thyrotropin, prolactin, and thyroid reserve, and metabolic impact on peripheral target tissues. Am J Med, 92(6): 631-42
Surks, M.I., Chopra, I.J., Mariash, C.N., Nicoloff, J.T., Solomon, D.H. (1990) American Thyroid Association guidelines for use of laboratory tests in thyroid disorders. JAMA, 263(11): 1529-32
Toft, A.D. (2001) Clinical practice: Subclinical hyperthyroidism. N Engl J Med, 345(7): 512-6
Trbojević, B. (1998) Štitasta žlezda - patofiziološke osnove i klinički pristup. Beograd: Zavod za udžbenike i nastavna sredstva
Trbojević, B., Micić, D. (2001) Subklinički hipotiroidizam. Glasnik Instituta za štitastu žlezdu i metabolizam 'Zlatibor', vol. 5, br. 2, str. 28-39
Tunbridge, W.M., Brewis, M., French, J.M., Appleton, D., Bird, T., Clark, F., Evered, D.C., Evans, J.G., Hall, R., Smith, P., Stephenson, J., Young, E. (1981) Natural history of autoimmune thyroiditis. Br Med J (Clin Res Ed), 282(6260): 258-62
Tunbridge, W.M., Evered, D.C., Hall, R., Appleton, D., Brewis, M., Clark, F., Evans, J.G., Young, E., Bird, T., Smith, P.A. (1977) Lipid profiles and cardiovascular disease in the Whickham area with particular reference to thyroid failure. Clin Endocrinol (Oxf), 7(6): 495-508
Vanderpump, M. (2003) Subclinical hypothyroidism: The case against treatment. u: Trends in Endocrinology and Metabolism
Vanderpump, M.P., Tunbridge, W.M., French, J.M., Appleton, D., Bates, D., Clark, F., Grimley, E.J., Hasan, D.M., Rodgers, H., Tunbridge, F. (1995) The incidence of thyroid disorders in the community: A twenty-year follow-up of the Whickham Survey. Clin Endocrinol (Oxf), 43(1): 55-68