指导治疗甲状腺功能减退:由美国甲状腺协会工作组甲状腺激素替代。

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Jonklaas J,比安科AC,鲍尔AJ,缅甸人KD, Cappola AR, Celi FS,库珀DS, Kim BW。彼得斯RP,罗森塔尔女士,索卡

指导治疗甲状腺功能减退:由美国甲状腺协会工作组甲状腺激素替代。

甲状腺。2014;12月24 (12):1670 - 751。doi: 10.1089 / thy.2014.0028。

PubMed ID

25266247 (在PubMed

]

文摘

背景:大量的最新进展对我们理解甲状腺生理可能解释为什么一些病人服用左旋甲状腺素单药治疗时感到不舒服。这个工作组的目的是审查左旋甲状腺素治疗的目标,传统的左旋甲状腺素治疗的最优处方,不满的来源左旋甲状腺素治疗,治疗证据替代品,相关的知识空白。我们想确定是否有足够的新数据生成的精心设计的研究提供理由追求这种疗法,改变目前的标准治疗。本文档旨在告知临床决策甲状腺激素替代疗法;它不是一个替代个性化的临床判断。方法:小组成员确认24问题与治疗甲状腺功能减退有关。每个问题的相关临床文献综述。临床评价补充相关时,与相关机械和长椅上研究文学评论,由我们的团队转化的科学家。必威国际app伦理审查提供相关时,生物伦理学家。回答问题是格式化的,在可能的情况下,正式的临床推荐的形式声明。 When responses were not suitable for a formal clinical recommendation, a summary response statement without a formal clinical recommendation was developed. For clinical recommendations, the supporting evidence was appraised, and the strength of each clinical recommendation was assessed, using the American College of Physicians system. The final document was organized so that each topic is introduced with a question, followed by a formal clinical recommendation. Stakeholder input was received at a national meeting, with some subsequent refinement of the clinical questions addressed in the document. Consensus was achieved for all recommendations by the task force. RESULTS: We reviewed the following therapeutic categories: (i) levothyroxine therapy, (ii) non-levothyroxine-based thyroid hormone therapies, and (iii) use of thyroid hormone analogs. The second category included thyroid extracts, synthetic combination therapy, triiodothyronine therapy, and compounded thyroid hormones. CONCLUSIONS: We concluded that levothyroxine should remain the standard of care for treating hypothyroidism. We found no consistently strong evidence for the superiority of alternative preparations (e.g., levothyroxine-liothyronine combination therapy, or thyroid extract therapy, or others) over monotherapy with levothyroxine, in improving health outcomes. Some examples of future research needs include the development of superior biomarkers of euthyroidism to supplement thyrotropin measurements, mechanistic research on serum triiodothyronine levels (including effects of age and disease status, relationship with tissue concentrations, as well as potential therapeutic targeting), and long-term outcome clinical trials testing combination therapy or thyroid extracts (including subgroup effects). Additional research is also needed to develop thyroid hormone analogs with a favorable benefit to risk profile.

DrugBank数据引用了这篇文章

药物

左旋甲状腺素

药物酶

药物	酶	类	生物	药理作用	行动
3,5-diiodothyropropionic酸	细胞色素P450 3 a4	蛋白质	人类	没有	底物	细节