Evaluacija tromesečne supstitucije levotiroksinom u simptomatskoj supkliničkoj hipotireozi: uticaj na kliničku sliku, kvalitet života i prihvatanje dugoročne terapije

  • Milena S. Pandrc Military Medical Academy, Clinic of Cardiology, Belgrade, Serbia
  • Andjelka Ristić Military Medical Academy, Clinic of Urgent Internal Medicine, Belgrade, Serbia
  • Vanja Kostovski Military Medical Academy, Clinic for Thoracic Surgery, Belgrade, Serbia
  • Violeta Randjelović Krstić Military Medical Academy, Clinic of Cardiology, Belgrade, Serbia
  • Jelena Milin Lazović Institute for Medical Statistics and Informatics, Clinical Center of Serbia, Belgrade, Serbia
  • Biljana Nedeljković Beleslin Clinical Center of Serbia, Clinic for Endocrinology, Diabetes and Metabolic Diseases, Belgrade, Serbia
  • Jasmina Ćirić Clinical Center of Serbia, Clinic for Endocrinology, Diabetes and Metabolic Diseases, Belgrade, Serbia
DOI: https://doi.org/10.2298/VSP180708157P
Ključne reči: hipotireoidizam, tiroksin, ankete i upitnici, lečenje, prekid, bolest, progresija, kvalitet života

Sažetak


Uvod/Cilj. Mada je supklinički hipotiroidizam (SCH) najčešće biohemijska dijagnoza, neki simptomi i znaci manifestne bolesti mogu biti prisutni i uticati na našu odluku o započinjanju lečenja levotiroksinom (LT4). Cilj ove studije bio je da se ispita efekat tromesečne supstitucije LT4-om na kliničku sliku i kvalitet života u simptomatskoj SCH sa vrednostima tiroidnog stimulišućeg hormona (TSH) < 10 mIU/L. Takođe, razmatrano je da li prekid lečenja dodatno doprinosi pouzdanosti dobijenih nalaza. Metode. Klinički parametri (bolest-specifičan upitnik) i kvalitet života (Short Form-36 upitnik – SF-36 ) procenjivani su kod 35 bolesnika sa perzistentnom simptomatskom SCH (TSH 7,0 ± 2,1 mIU/L) pre intervencije (LT4), tri meseca nakon postizanja zadovoljavajućeg kvaliteta supstitucije i tri meseca nakon prekida lečenja. Rezultati. Medijana Zulewski indeksa bila je značajno snižena nakon lečenja LT4-om: 5,0 (4,0–7,0) vs. 3,0 (2,0–5,0) (p < 0,001), što je bilo praćeno smanjenjem tegoba. Najučestalija tegoba pre tretmana bila je suva koža (71,4%), nagluvost (65,7%) i gruba i perutava koža (54,3%). Nakon lečenja, zabeležen je značajan pad u učestalosti opstipacije (p = 0,004), suve kože (p = 0,022), nagluvosti (p = 0,002), smanjenog znojenja (p = 0,006) i produženog Ahilovog refleksa (p = 0,002). Kvalitet života nije značajno promenjen ovim tretmanom. U grupi od 18 bolesnika koji su prekinuli lečenje, sa porastom TSH (6,8 ± 1,1 mIU/L) brojni simptomi i znaci su se ponovo javili: periorbitalni edem, opstipacija, porast telesne mase, smanjeno znojenje, usporenost i produžen Ahilov refleks. Medijana Żulewski indeksa nakon prekida uzimanja LT4 iznosila je 6,0 (4,0–9,0) (p = 0,010). Takođe, došlo je do značajnog pada u skorovima SF-36 upitnika koji se odnose na opšte zdravstveno stanje, vitalnost, emocionalnu komponentu i mentalno zdravlje. Zaključak. Klinički skor baziran na simptomima i znacima je senzitivan i reproducibilan test za objektivizaciju procene efekata supstitucije LT4-om kod bolesnika sa simptomatskom SCH (TSH < 10 mIU/L), što govori u prilog individualnom pristupu u lečenju. Simptomatska SCH nije neophodno udružena sa oštećenim kvalitetom života, ali on može biti značajno poboljšan lečenjem. Promene u opštem zdravstvenom statusu, vitalnosti, mentalnom stanju i emocionalnoj ulozi nakon prekida lečenja sugerišu da neki aspekti kvaliteta života mogu biti zahvaćeni suptilnim promenama u nivou dostupnog tiroksina.

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Objavljeno
2021/03/04
Broj časopisa
Vol. 77 Br. 9 (2020): Vojnosanit pregl
Rubrika
Originalni članak