2019年10月31日木曜日

80歳以上の潜在性甲状腺機能低下症治療

80歳以上の251名の被験者を含む2つのRCTからのpooled analysisで、levothyroxine治療をプラシーボと比較して、甲状腺関連患者報告QOLアウトカムスコア(range 0-100: 高スコアほどQOL悪化し、MCID 9)で、甲状腺機能低下症状に関するスコア 補正群間差 1.3、倦怠感 に関するスコア 補正群間差 0.1


結論:80歳を超える高齢者に対して、潜在性(無症候性)甲状腺機能低下症に対するレボサイロキシンのルーチン治療を支持できない


Association Between Levothyroxine Treatment and Thyroid-Related Symptoms Among Adults Aged 80 Years and Older With Subclinical Hypothyroidism
Simon P. Mooijaart, et al.
JAMA. Published online October 30, 2019. doi:10.1001/jama.2019.17274
https://jamanetwork.com/journals/jama/article-abstract/2753909





日本内科学会雑誌では85歳以上を除外
https://www.jstage.jst.go.jp/article/naika/99/4/99_707/_pdf




付録


Subclinical Hypothyroidism
A Review
Bernadette Biondi, MD1; Anne R. Cappola, MD, ScM2,3; David S. Cooper, MD4
JAMA. 2019;322(2):153-160. doi:10.1001/jama.2019.9052


Differential Diagnosis of Elevated Serum Thyrotropin and Normal Serum Free Thyroxinea
Subclinical Hypothyroidism Due to Mild Thyroid Failure
Chronic lymphocytic thyroiditis (Hashimoto thyroiditis)
Inadequate levothyroxine replacement therapy for overt hypothyroidism
Following thyroid lobectomy
Following antithyroid drug or radioiodine therapy for hyperthyroidism Following external beam radiotherapy to the head and neck Infiltrative disorders such as amyloidosis and Riedel thyroiditis Following an episode of subacute (granulomatous) thyroiditis

Drug induced, especially in patients with underlying lymphocytic thyroiditis
Lithium carbonate
Iodine-containing compounds, including amiodarone Interferon alfa

Tyrosine kinase inhibitors, immune check point inhibitors
Physiological Transient Rises in Thyrotropin Levels
Recovery after severe nonthyroidal illness During recovery from various forms of thyroiditis
Following withdrawal of chronic levothyroxine therapy in a euthyroid individual
Seasonal (wintertime) increases in serum thyrotropin
Elevated Serum Thyrotropin Levels
That Are Not True Subclinical Hypothyroidism
Common causes
Increases in elderly persons without thyroid disease
Increases in patients with marked obesity, typically with body mass index of more than 40
Uncommon causes
Anomalous laboratory results due to heterophilic antibodies or macroTSH

Untreated adrenal insufficiency
Abbreviation: TSH indicates thyroid-stimulating hormone (thyrotropin).
a1 Modified from Cooper and Biondi.






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