背景:尽管TSH水平正常,但甲状腺功能减退患者的持续症状提示需要替代治疗。本研究旨在评估T4和T3联合治疗或甲状腺干燥(DTE)与T4单药治疗相比的有效性。专注于甲状腺特征,血脂谱,和生活质量指标。
方法:我们在Embase进行了系统综述,Medline/PubMed,和WebofScience到2023年11月23日。我们使用了以下关键词:\"护甲甲状腺,“或”甲状腺提取物,“或”自然干燥的甲状腺,“或”自然-机器人,“\”甲状腺干燥,\"或\"np甲状腺,\"或\"Synthroid,“或”左甲状腺素,\"或\"Liothyronine,\"\"Cytomel,“或”甲状腺USP,\"或\"单键。“和”甲状腺功能减退。“我们只包括RCT,排除非RCT,病例对照研究,非英语文章
结果:从6,394条确定的记录中,16项研究经过筛选和资格检查合格。我们纳入了两项关于甲状腺干燥的研究和15项关于联合治疗的研究。在这个荟萃分析中,T4+T3联合治疗显示游离T4水平显著降低(平均差异(MD):-0.34;95%CI:-0.47,-0.20),总T4水平(平均差:-2.20;95%CI:-3.03,-1.37),和GHQ-28得分(MD:-2.89;95%CI:-3.16,-2.63),与T4单一疗法相比。联合治疗组的总T3水平显著升高(MD:29.82;95%CI:22.40,37.25)。分析表明中度到高度异质性。心率无显著差异,SHBG,TSH,脂质轮廓,TSQ-36和BDI评分。与T4单一疗法相比,接受DTE的受试者的血清总T3水平显着升高(MD:50.90;95%CI:42.39,59.42),血清总T4水平显着降低(MD:-3.11;95%CI:-3.64,-2.58)和游离T4水平(MD:-0.50;95%CI:-0.57,-0.43)。此外,DTE治疗显示TSH水平略有升高(MD:0.49;95%CI:0.17,0.80)。分析表明异质性较低。心率无显著差异,SHBG,脂质轮廓,TSQ-36、GHQ-28和BDI评分。
结论:我们的研究表明,联合治疗和DTE导致较高的T3和较低的T4水平,与T4单药治疗甲状腺功能减退症相比。然而,对心率没有显著影响,血脂谱,或生活质量被注意到。鉴于结果的异质性,建议采用个性化治疗方法。
BACKGROUND: Persistent symptoms in hypothyroid patients despite normalized TSH levels suggest the need for alternative treatments. This study aims to evaluate the effectiveness of combined T4 and T3 therapy or desiccated thyroid (DTE) compared to T4 monotherapy, with a focus on thyroid profile, lipid profile, and quality of life metrics.
METHODS: We conducted a systematic
review in Embase, Medline/PubMed, and Web of Science up to 11/23/2023. We used the following keywords: \"Armour Thyroid,\" OR \"Thyroid extract,\" OR \"Natural desiccated thyroid,\" OR \"Nature-Throid,\" \"desiccated thyroid,\" OR \"np thyroid,\" OR \"Synthroid,\" OR \"levothyroxine,\" OR \"Liothyronine,\" \"Cytomel,\" OR \"Thyroid USP,\" OR \"Unithroid.\" AND \"hypothyroidism. \" We only included RCTs and excluded non-RCT, case-control studies, and non-English articles.
RESULTS: From 6,394 identified records, 16 studies qualified after screening and eligibility checks. We included two studies on desiccated thyroid and 15 studies on combined therapy. In this meta-analysis, combination therapy with T4 + T3 revealed significantly lower Free T4 levels (mean difference (MD): -0.34; 95% CI: -0.47, -0.20), Total T4 levels (mean difference: -2.20; 95% CI: -3.03, -1.37), and GHQ-28 scores (MD: -2.89; 95% CI: -3.16, -2.63), compared to T4 monotherapy. Total T3 levels were significantly higher in combined therapy (MD: 29.82; 95% CI: 22.40, 37.25). The analyses demonstrated moderate to high heterogeneity. There was no significant difference in Heart Rate, SHBG, TSH, Lipid profile, TSQ-36, and BDI Score. Subjects on DTE had significantly higher serum Total T3 levels (MD: 50.90; 95% CI: 42.39, 59.42) and significantly lower serum Total T4 (MD: -3.11; 95% CI: -3.64, -2.58) and Free T4 levels (MD: -0.50; 95% CI: -0.57, -0.43) compared to T4 monotherapy. Moreover, DTE treatment showed modestly higher TSH levels (MD: 0.49; 95% CI: 0.17, 0.80). The analyses indicated low heterogeneity. There was no significant difference in Heart Rate, SHBG, Lipid profile, TSQ-36, GHQ-28, and BDI Score.
CONCLUSIONS: Our study revealed that combined therapy and DTE lead to higher T3 and lower T4 levels, compared to T4 monotherapy in hypothyroidism. However, no significant effects on heart rate, lipid profile, or quality of life were noted. Given the heterogeneity of results, personalized treatment approaches are recommended.