ketendoКлиническая и экспериментальная тиреоидологияClinical and experimental thyroidology1995-54722310-3787Endocrinology Research Centre10.14341/ket10163ketendo-10163Research ArticleОбзоры литературыReview of literatureПричины неэффективности заместительной терапии первичного гипотиреозаCauses of treatment failure in primary hypothyroidismhttps://orcid.org/0000-0001-7210-1853МануйловаЮлия АлександровнаManuylovaYulia A.

к.м.н., ассистент кафедры

MD, PhD

juliakolish@yahoo.comhttps://orcid.org/0000-0003-1500-1586МоргуноваТатьяна БорисовнаMorgunovaTatyana B.

к.м.н.

MD, PhD

tanmorgun@mail.ruhttps://orcid.org/0000-0002-2504-7468ФадеевВалентин ВикторовичFadeyevValentin V.

д.м.н., профессор, член-корр. РАН

MD, PhD, Professor

walfad@mail.ru<p>ФГАОУ ВО Первый МГМУ им. И.М. Сеченова Минздрава России (Сеченовский Университет)</p>Россия<p>I.M. Sechenov First Moscow State Medical University (Sechenov University)</p>Russian Federation2019200820191511218Copyright &#x00A9; Мануйлова Ю.А., Моргунова Т.Б., Фадеев В.В., 20192019Мануйлова Ю.А., Моргунова Т.Б., Фадеев В.В.Manuylova Y.A., Morgunova T.B., Fadeyev 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.cet-endojournals.ru/jour/article/view/10163

Первичный гипотиреоз – это одно из наиболее распространенных эндокринных заболеваний. Учитывая эффективность, хорошую переносимость, простоту титрации дозы, низкую стоимость и длительный период полувыведения, левотироксин остается препаратом первой линии для лечения гипотиреоза. Несмотря на отсутствие видимых сложностей при проведении заместительной терапии, в состоянии декомпенсации находятся от 30 до 60% пациентов во всем мире. Некомпенсированный гипотиреоз может сопровождаться такими неблагоприятными последствиями, как снижение работоспособности и настроения, ухудшение самочувствия и качества жизни, возникновение сердечно-сосудистых заболеваний, нарушения ритма сердца и переломы. В представленном обзоре литературы обсуждаются наиболее частые причины неэффективности заместительной терапии гипотиреоза. Наиболее частыми причинами недостижения компенсации заболевания являются неправильный прием препарата (после еды, употребление сразу после левотироксина кофе, молока), несоблюдение условий хранения (применение по истечении срока годности, чрезмерный нагрев), недостаточная приверженность пациента лечению (пропуск приема препарата), влияние других лекарственных препаратов (препараты кальция, железа, ингибиторы протонной помпы и т.д.), заболевания желудочно-кишечного тракта (атрофический гастрит, целиакия), отсутствие коррекции терапии врачом, психологическое состояние пациента (депрессия, снижение когнитивных функций), смена препарата левотироксина. С учетом такого большого количества факторов, влияющих на достижение и поддержание компенсации гипотиреоза, необходимо перед коррекцией дозы выяснить и по возможности устранить фактор, приведший к декомпенсации.

Primary hypothyroidism is one of the most common endocrine diseases. Levothyroxine is the treatment of choice due to its efficacy, good tolerance, simplicity of a dose titration, low cost and long elimination half-life. Replacement therapy for hypothyroidism is simple and convenient, but from 30 to 60% of patients are in a state of decompensation. Over- or underreplacement with L-T4 may lead to serious adverse events such as decreased performance and mood, deterioration of health and quality of life, developing of cardiovascular diseases, cardiac arrhythmias and bone fractures. The most common reasons for failure to compensate for the disease are improper administration of the drug (after eating, drinking coffee and milk immediately after levothyroxine), non-compliance with storage conditions (use after the expiration date, excessive heat), insufficient patient adherence to treatment (skipping the drug), the effect of other medicines drugs (calcium, iron preparations, proton pump inhibitors, etc.), diseases of the gastrointestinal tract (atrophic gastritis, celiac disease). Given many factors influencing the achievement and maintenance of compensation for hypothyroidism, it is necessary to determine and, if possible, eliminate the main factor leading to decompensation before the dose adjustment.

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