References

medsovet

Медицинский Совет

Meditsinskiy sovet = Medical Council

2079-701X2658-5790

REMEDIUM GROUP Ltd.

10.21518/2079-701X-2020-7-96-107

medsovet-5661

Research Article

ДРУГИЕ ПРОБЛЕМЫ ЭНДОКРИНОЛОГИИ

OTHER PROBLEMS OF ENDOCRINOLOGY

Гипотиреоз: современное состояние проблемы

Hypothyroidism: current state of the problem

https://orcid.org/0000-0001-9007-4123

Бирюкова

Е. В.

Biryukova

E. V.

Бирюкова Елена Валерьевна, д.м.н., профессор кафедры эндокринологии и диабетологии

127473, Россия, Москва, ул. Делегатская, д. 20, стр. 1

Elena V. Biryukova, Dr. of Sci. (Med.), Professor of the Department of Endocrinology and Diabetology

20, b. 1, Delegateskaya St., Moscow, 127473, Russia

lena@obsudim.ru

Килейников

Д. В.

Kileynikov

D. V.

Килейников Денис Васильевич, к.м.н., доцент кафедры эндокринологии и диабетологии

127473, Россия, Москва, ул. Делегатская, д. 20, стр. 1

Denis V. Kileynikov, Cand. of Sci. (Med.), Associate Professor of the Department of Endocrinology and Diabetology

20, b. 1, Delegateskaya St., Moscow, 127473, Russia

https://orcid.org/0000-0002-2125-622X

Соловьева

И. В.

Solovyeva

I. V.

Соловьева Инна Владимировна, ассистент кафедры эндокринологии и диабетологии

127473, Россия, Москва, ул. Делегатская, д. 20, стр. 1

Inna V. Solovyeva, Assistant of the Department of Endocrinology and Diabetology

20, b. 1, Delegateskaya St., Moscow, 127473, Russia

Московский государственный медико-стоматологический университет им. А.И. ЕвдокимоваРоссияA.I. Yevdokimov Moscow State University of Medicine and DentistryRussian Federation

2020

28052020

0796107

2020

Бирюкова Е.В., Килейников Д.В., Соловьева И.В.

Biryukova E.V., Kileynikov D.V., Solovyeva I.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/5661

В статье отражены вопросы эпидемиологии, классификации, клиники гипотиреоза. Частота гипотиреоза значительно растет с возрастом. Наиболее распространенной формой является первичный гипотиреоз, вызванный патологическим процессом в самой щитовидной железе. Вторичный гипотиреоз или третичный обусловлен недостаточностью секреции тиреотропного гормона (ТТГ), или тиролиберина. В статье рассмотрены основные причины первичного и вторичного гипотиреоза. Самая частая причина первичного гипотиреоза – аутоиммунный тиреоидит, который может развиваться как отдельно, так и одновременно с другими аутоиммунными заболеваниями, в рамках полигландулярного синдрома. Отдельного внимания заслуживает изменение тиреоидного статуса как следствие неблагоприятных побочных реакций при использовании ряда препаратов. Подняты вопросы о механизмах развития тиреоидной недостаточности как результата неблагоприятных побочных реакций при использовании ряда препаратов (препараты лития, йодосодержащие соединения, ингибиторы тирозинкиназы и др.). Недиагностированный гипотиреоз является фактором риска прогрессирования уже имеющихся сердечно-сосудистых заболеваний. Тяжесть клинических проявлений определяется выраженностью дефицита тиреоидных гормонов. Существенных клинических отличий между выраженными формами первичного и вторичного гипотиреоза нет. В зависимости от степени поражения вторичный гипотиреоз может осложниться другими проявлениями гипоталамо-гипофизарных нарушений, равно как последние могут включать на определенном этапе их развития понижение секреции антидиуретического гормона. Обсуждаются сложности диагностики заболевания, поскольку гипотиреоз нарушает функционирование большинства органов и систем организма (костно-мышечной, сердечно-сосудистой, мочевыводящей системы, опорно-двигательного аппарата, желудочно-кишечного тракта, центральной и периферической нерв- ной системы) и может маскироваться различными заболеваниями. Окончательный диагноз гипотиреоза уточняется рядом лабораторных и инструментальных исследований. Для лечения гипотиреоза любой этиологии используется заместительная терапия левотироксином.

The article presents the issues of epidemiology, classification, and clinic of hypothyroidism. The frequency of hypothyroidism increases significantly with age. The most common form is primary hypothyroidism, caused by a pathological process in the thyroid gland itself. Secondary hypothyroidism or tertiary hypothyroidism is caused by insufficient secretion of thyroid- stimulating hormone (TSH), or thyrotropin-releasing hormone. The article deals with the main causes of primary and secondary hypothyroidism. The most common cause of primary hypothyroidism is autoimmune thyroiditis, which can develop both separately and simultaneously with other autoimmune diseases, as part of polyglandular syndrome. Special attention should be paid to the change of thyroid status as a result of adverse side reactions when using a range of drugs. The questions about the mechanisms of thyroid insufficiency development as a result of unfavorable side reactions when using a number of drugs (lithium preparations, iodine-containing compounds, tyrosine kinase inhibitors, etc.) have been raised. Undiagnosed hypothyroidism is a risk factor for the progression of already existing cardiovascular diseases. The severity of clinical manifestations is determined by the severity of thyroid hormone deficiency. There are no significant clinical differences between the pronounced forms of primary and secondary hypothyroidism. Depending on the degree of lesion, secondary hypothyroidism may be complicated by other manifestations of hypothalamic-pituitary disorders, as well as the latter may include a decrease in the secretion of antidiuretic hormone at a certain stage of their development. Diagnostic difficulties are discussed, as hypothyroidism disrupts the functioning of most organs and systems of the body (musculoskeletal, cardiovascular, urinary, gastrointestinal, central and peripheral nervous systems) and can be masked by various diseases. The final diagnosis of hypothyroidism is clarified by a number of laboratory and instrumental studies. Substitution therapy with levothyroxine is used to treat hypothyroidism of any etiology.

гипотиреозаутоиммунный тиреоидитТТГтиреоидные гормонымедикаментозно-индуцированный гипотиреоззаместительная терапиялевотироксин

hypothyroidismautoimmune thyroiditisTSHthyroid hormonesdrug-induced hypothyroidismsubstitution therapylevothyroxine

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