不同剂量左旋甲状腺素钠治疗老年亚临床甲状腺功能减退症的有效性和安全性比较  

Comparison of Efficacy and Safety of Different Doses of Levothyroxine Sodium in the Treatment of Subclinical Hypothyroidism in the Elderly

作　　者：卢天孟 李琼[1] 赖鸿鹄[1] 张瑞生 梁辉燕 LU Tianmeng;LI Qiong;LAI Honghu;ZHANG Ruisheng;LIANG Huiyan(Department of Endocrinology,Gaozhou people’s Hospital,Gaozhou,Guangdong 525200)

机构地区：[1]高州市人民医院内分泌内科,广东高州525200

出　　处：《智慧健康》2022年第8期86-88,共3页Smart Healthcare

摘　　要：目的比较应用大剂量与小剂量左旋甲状腺素钠治疗老年亚临床甲状腺功能减退症的有效性和安全性。方法选择2019年2月-2021年2月到我院就诊的62例亚临床甲状腺功能减退症老年患者作为研究对象,以随机抽签法将其随机分为小剂量组和大剂量组,每组各31例。两组均应用左旋甲状腺素钠治疗,其中小剂量组起始剂量为12.5μg/d,维持剂量25~50μg/d,每隔2周增加12.5μg/d;大剂量组起始剂量25.0μg/d,维持剂量75~100μg/d,每隔2周增加25.0μg/d。两组持续用药12周。比较两组治疗总有效率、治疗前后甲状腺功能变化以及不良反应发生率。结果大剂量组治疗总有效率93.55%,与小剂量组83.87%对比无明显的差异(P>0.05)。两组治疗前血清TSH、FT3、FT4水平比较差异无统计学意义(P>0.05),但经治疗后大剂量组的血清TSH水平显著低于小剂量组(P<0.05)。小剂量组的药物不良反应发生率6.45%,显著低于大剂量组的25.81%(P<0.05)。结论大剂量与小剂量左旋甲状腺素钠治疗老年亚临床甲状腺功能减退症效果相当,但应用大剂量左旋甲状腺素钠能够更好地改善患者甲状腺功能,而小剂量左旋甲状腺素钠的不良反应更少,临床应根据患者实际病情合理选择剂量,保障治疗有效安全。Objective To compare the efficacy and safety of high-dose and low-dose levothyroxine sodium in the treatment of subclinical hypothyroidism in the elderly.Methods 62 cases of elderly patients with subclinical hypothyroidism who visited our hospital from February 2019 to February 2021 were selected as the research object.They were randomly divided into low-dose group and highdose group,with 31 cases in each group.Both groups were treated with levothyroxine sodium,and the initial dose in the low-dose group was 12.5μg/d,maintenance dose 25~50μg/d,increased by 12.5μg/d every 2 weeks;The initial dose of high-dose group was 25.0μg/d,maintenance dose 75~100μg/d,increased by 25.0μg/d every 2 weeks.The two groups were treated for 12 weeks.The total effective rate,the changes of thyroid function(TSH,FT3,FT4)and the incidence of adverse reactions were compared between the two groups.Results The total effective rate of the high-dose group was 93.55%,which had no significant difference compared with 83.87%in the low-dose group(P>0.05).There were no significant difference in the levels of serum TSH,FT3 and FT4 between the two groups before treatment(P>0.05).After treatment,the levels of serum TSH in the high-dose group wassignificantly better than the low-dose group(P<0.05).The incidence of adverse drug reactions in the low-dose group was 6.45%,significantly lower than 25.81%in the high-dose group(P<0.05).Conclusion High-dose and low-dose levothyroxine sodium have similar effects in the treatment of subclinical hypothyroidism in the elderly,but the application of high-dose levothyroxine sodium can better improve the patient’s thyroid function,while low-dose levothyroxine sodium has fewer adverse effects.The clinical dose should be selected reasonably according to the actual condition of the patient to ensure effective and safe treatment.

关 键 词：亚临床甲状腺功能减退症 老年患者 左旋甲状腺素钠 不同剂量 

分 类 号：R581.2[医药卫生—内分泌]