medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2017-3-64-67medsovet-1752Research ArticleДРУГИЕ ПРОБЛЕМЫ ЭНДОКРИНОЛОГИИOTHER PROBLEMS OF ENDOCRINOLOGYВТОРИЧНЫЙ ГИПОТИРЕОЗ: СОВРЕМЕННЫЕ ПОДХОДЫ К ДИАГНОСТИКЕ И ЛЕЧЕНИЮSECONDARY HYPOTHYROIDISM: CURRENT APPROACHES TO DIAGNOSIS AND TREATMENTГавриловаТ. А.GavrilovaT. A.МоргуноваТ. Б.MorgunovaT. B.

к.м.н.,

PhD in medicine

ФадеевВ. В.FadeevV. V.

д.м.н., профессор, чл.-корр. РАН

MD, Prof., corresponding member of the RAS

Первый Московский государственный медицинский университет им. И.М. Сеченова РоссияFirst Moscow State Medical University named after I.M. Sechenov Russian Federation201730122017036467Copyright © Гаврилова Т.А., Моргунова Т.Б., Фадеев В.В., 20172017Гаврилова Т.А., Моргунова Т.Б., Фадеев В.В.Gavrilova T.A., Morgunova T.B., Fadeev V.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/1752

Вторичный гипотиреоз является крайне редкой причиной гипотиреоза у взрослых. Клинические проявления вторичного, так же как и первичного, гипотиреоза неспецифичны, кроме того, недостаточность тиреоидных гормонов зачастую маскируется проявлениями дефицита других тропных гормонов, что затрудняет своевременную диагностику данного заболевания. Определенные трудности вызывает также заместительная терапия вторичного гипотиреоза, поскольку критерием оценки дозы левотироксина служит уровень свободного тироксина в крови, а вопросы об использовании периферических маркеров эффектов тиреоидных гормонов для оценки адекватности проводимой терапии остаются недостаточно изученными.

Secondary hypothyroidism is a very rare cause of hypothyroidism in adults. Clinical manifestations of secondary as well as primary hypothyroidism are nonspecific; in addition, thyroid hormone deficiency often clinically simulates other tropic hormone deficiencies, thus complicating timely diagnosis of the disease. Certain difficulties are also caused by replacement therapy in secondary hypothyroidism, since the level of free thyroxine in the blood is used as the criterion for evaluating levothyroxine dosage, and questions about the use of peripheral markers of thyroid function to assess the adequacy of therapy remain understudied.

вторичный гипотиреоздиагностиказаместительная терапиялевотироксиноценка адекватности терапииsecondary hypothyroidismdiagnosticsreplacement therapylevothyroxineassessment of the adequacy of therapyReferencesAlexopoulou 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.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.Andersen S, Pedersen K.M., Bruun N.H., Laurberg P. Hospital A. Narrow individual variations in serum T(4) and T(3) in normal subjects: a clue to the understanding of subclinical thyroid disease. J Clin Endocrinol Metab, 2002 Mar, 87(3): 1068-72.Andersen S, Pedersen K.M., Bruun N.H., Laurberg P. Hospital A. Narrow individual variations in serum T(4) and T(3) in normal subjects: a clue to the understanding of subclinical thyroid disease. J Clin Endocrinol Metab, 2002 Mar, 87(3): 1068-72.Atmaca H, Tanriverdi F, Gokce C et al. Do we still need the TRH stimulation test? Thyroid, 2007 Jun, 17(6): 529-33.Atmaca H, Tanriverdi F, Gokce C et al. Do we still need the TRH stimulation test? Thyroid, 2007 Jun, 17(6): 529-33.Beck-Peccoz P, Persani L. Variable biological activity of thyroid-stimulating hormone. Eur J Endocrinol, 1994 Oct, 131(4): 331-40.Beck-Peccoz P, Persani L. Variable biological activity of thyroid-stimulating hormone. Eur J Endocrinol, 1994 Oct, 131(4): 331-40.Feldt-Rasmussen U, Klose M. Central hypothyroidism and its role for cardiovascular risk factors in hypopituitary patients. Endocrine, 2016 Oct, 54(1): 15-23. DOI: 10.1007/s12020-016-1047-x. Epub 2016 Aug 1.Feldt-Rasmussen U, Klose M. Central hypothyroidism and its role for cardiovascular risk factors in hypopituitary patients. Endocrine, 2016 Oct, 54(1): 15-23. DOI: 10.1007/s12020-016-1047-x. Epub 2016 Aug 1.Ferretti E, Persani L, Giambona S et al. Evaluation of the Adequacy of Levothyroxine Central Hypothyroidism. J Clin Endocrinol Metab, 1999 Mar, 84(3): 924-9.Ferretti E, Persani L, Giambona S et al. Evaluation of the Adequacy of Levothyroxine Central Hypothyroidism. J Clin Endocrinol Metab, 1999 Mar, 84(3): 924-9.Gonc EN, Yordam N, Ozon A et al. Endocrinological outcome of different treatment options in children with craniopharyngioma: a retrospective analysis of 66 cases. Pediatr. Neurosurg. Switzerland, 2004, 40(3): 112-119.Gonc EN, Yordam N, Ozon A et al. Endocrinological outcome of different treatment options in children with craniopharyngioma: a retrospective analysis of 66 cases. Pediatr. Neurosurg. Switzerland, 2004, 40(3): 112-119.Grunenwald S, Caron P. Central hypothyroidism in adults: better understanding for better care. Pituitary, 2015 Feb, 18(1): 169-75. doi: 10.1007/s11102-014-0559-8.Grunenwald S, Caron P. Central hypothyroidism in adults: better understanding for better care. Pituitary, 2015 Feb, 18(1): 169-75. doi: 10.1007/s11102-014-0559-8.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.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.Jonklaas J, Bianco AC, Bauer AJ et al. Guidelines for the treatment of hypothyroidism: prepared by the american thyroid association task force on thyroid hormone replacement. Thyroid, 2014 Dec, 24(12): 1670-751. doi: 10.1089/thy.2014.0028.Jonklaas J, Bianco AC, Bauer AJ et al. Guidelines for the treatment of hypothyroidism: prepared by the american thyroid association task force on thyroid hormone replacement. Thyroid, 2014 Dec, 24(12): 1670-751. doi: 10.1089/thy.2014.0028.Littley MD, Shalet SM, Beardwell CG et al. Radiation induced hypopituitarism is dose-dependent. Clin Endocrinol (Oxf), 1989, 31: 363-373.Littley MD, Shalet SM, Beardwell CG et al. Radiation induced hypopituitarism is dose-dependent. Clin Endocrinol (Oxf), 1989, 31: 363-373.Ormston BJ, Cryer RJ, Garry R et al. Thyrotrophin-releasing hormone as a thyroid-function test. Lancet, 1971 Jul 3, 2(7714): 10-4.Ormston BJ, Cryer RJ, Garry R et al. Thyrotrophin-releasing hormone as a thyroid-function test. Lancet, 1971 Jul 3, 2(7714): 10-4.Persani L, Ferretti E, Borgato S et al. Circulating thyrotropin bioactivity in sporadic central hypothyroidism. J Clin Endocrinol Metab, 2000 Oct, 85(10): 3631-5.Persani L, Ferretti E, Borgato S et al. Circulating thyrotropin bioactivity in sporadic central hypothyroidism. J Clin Endocrinol Metab, 2000 Oct, 85(10): 3631-5.Persani L., Bonomi M. Uncertainties in endocrine substitution therapy for central endocrine insufficiencies : hypothyroidism. Handb Clin Neurol, 2014, 124: 397-405. doi: 10.1016/B978-0-444-59602-4.00027-7.Persani L., Bonomi M. Uncertainties in endocrine substitution therapy for central endocrine insufficiencies : hypothyroidism. Handb Clin Neurol, 2014, 124: 397-405. doi: 10.1016/B978-0-444-59602-4.00027-7.Price A, Weetman AP. Screening for central hypothyroidism is unjustified. BMJ, 2001 Mar 31, 322(7289): 798.Price A, Weetman AP. Screening for central hypothyroidism is unjustified. BMJ, 2001 Mar 31, 322(7289): 798.Samuels M.H., Ridgway E.C. Central hypothyroidism. Endocrinol Metabol Clin North Am, 1992, 21: 903-919.Samuels M.H., Ridgway E.C. Central hypothyroidism. Endocrinol Metabol Clin North Am, 1992, 21: 903-919.Slawik M, Klawitter B, Meiser E et al. 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. DOI: 10.1210/jc.2007-0297. Epub 2007 Aug 21.Slawik M, Klawitter B, Meiser E et al. 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. DOI: 10.1210/jc.2007-0297. Epub 2007 Aug 21.Toft AD. Thyroxine therapy. N Engl J Med, 1994 Jul 21, 331(3): 174-80.Toft AD. Thyroxine therapy. N Engl J Med, 1994 Jul 21, 331(3): 174-80.Yamada M, Mori M. Mechanisms related to the pathophysiology and management of central hypothyroidism. Nat Clin Pract Endocrinol Metab, 2008 Dec, 4(12): 683-94. doi: 10.1038/ncpendmet0995.Yamada M, Mori M. Mechanisms related to the pathophysiology and management of central hypothyroidism. Nat Clin Pract Endocrinol Metab, 2008 Dec, 4(12): 683-94. doi: 10.1038/ncpendmet0995.

The authors declare that there are no conflicts of interest present.