članak: 1 od 1  
Medicinski glasnik Specijalna bolnica za bolesti štitaste žlezde i bolesti metabolizma Zlatibor
2007, vol. 12, br. 21, str. 16-20
jezik rada: srpski
neklasifikovan
Hipotireoza - dijagnostičke i terapijske dileme
Univerzitet u Beogradu, Medicinski fakultet, Klinički centar Srbije

e-adresa: mzarkov@eunet.yu

Sažetak

Uobičajene referentne vrednosti za TSH su od 0.4 do 4.0 mU/L. Međutim, 95 % zdrave populacije ima koncentraciju TSH manju od 2.6 mU/L. Stoga je predloženo je da se opseg referentnih vrednosti za TSH promeni, na 0.4 do 2.5 mU/L. Svi eksperti se ne slažu sa potrebom promene referentne vrednosti, mada prihvataju da bar polovina subjekata sa koncentracijom TSH između 2.5 i 4 mU/L ima tiroidnu disfunkciju. Kriterijumi za lečenje subkliničke hipotireoze su vrlo raznoliki. Neki autori zastupaju da subkliničku hipotireozu ne treba lečiti dok ne dođe do pada koncentracije FT4. Drugi smatraju da treba uzeti u obzir i koncentraciju TSH i prisustvo antiTPO antitela. Ukoliko je TSH veći od 10 mU/L, ili ukoliko su prisutna antiTPO antitela, treba uvesti supstituciju. Negro i saradnici su trudnicama sa pozitivnim antiTPO antitelima i normalnom tiroidnom funkcijom uveli terapiju tiroksinom tokom rane trudnoće. U poređenju sa trudnicama sa antiTPO antitelima koje nisu lečene tiroksinom, ishod trudnoće u lečenih trudnica bio je značajno bolji, što se manifestovalo smanjenim brojem pobačaja i prevremenih porođaja. U trudnoći treba koristiti specifične referentne opsege za TSH i FT4. U svakom slučaju treba agresivno dijagnostikovati hipotireozu u trudnoći, naročito kod trudnica sa drugim autoimunim bolestima ili simptomima hipotireoze.

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