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首页> 外文期刊>Thyroid Research >Management of hypothyroidism with combination thyroxine (T4) and triiodothyronine (T3) hormone replacement in clinical practice: a review of suggested guidance
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Management of hypothyroidism with combination thyroxine (T4) and triiodothyronine (T3) hormone replacement in clinical practice: a review of suggested guidance

机译：在临床实践中结合甲状腺素（T4）和三碘甲状腺素（T3）激素替代治疗甲状腺功能减退症：建议指南的回顾

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Whilst trials of combination levothyroxine/liothyronine therapy versus levothyroxine monotherapy for thyroid hormone replacement have not shown any superiority, there remains a small subset of patients who do not feel well on monotherapy. Whilst current guidelines do not suggest routine use of combination therapy they do acknowledge a trial in such patients may be appropriate. It appears that use of combination therapy and dessicated thyroid extract is not uncommon but often being used by non-specialists and not adequately monitored. This review aims to provide practical advice on selecting patients, determining dose and monitoring of such a trial. It is important to select the correct patient for a trial so as to not delay diagnosis or potentially worsen an undiagnosed condition. An appropriate starting dose may be calculated but accuracy is limited by available formulations and cost. Monitoring of thyroid function, benefits and adverse effects are vital in the trial setting given lack of evidence of safe long term use. Also important is that patients understand set up of the trial, potential risks involved and give consent. Whilst evidence is lacking on whether a small group of patients may benefit from combination therapy a trial may be indicated in those who remain symptomatic despite adequate levothyroxine monotherapy. This should be undertaken by clinicians experienced in the field with appropriate monitoring for adverse outcomes in both short and long term.
机译：尽管左甲状腺素/碘甲状腺素联合左旋甲状腺素联合单药治疗甲状腺激素替代疗法没有显示出任何优势，但仍有少数患者在单药治疗中感觉不适。尽管目前的指南并未建议常规使用联合疗法，但他们确实承认在此类患者中进行试验可能是适当的。看来结合治疗和甲状腺干提取物的使用并不少见，但通常由非专科医生使用且未得到充分监测。这篇综述旨在为选择患者，确定剂量和监测此类试验提供实用建议。重要的是选择正确的患者进行试验，以免延误诊断或使未诊断的病情恶化。可以计算适当的起始剂量，但准确性受到可用制剂和成本的限制。鉴于缺乏长期安全使用的证据，对甲状腺功能，益处和不良反应的监测在试验环境中至关重要。同样重要的是，患者应了解试验的设置，所涉及的潜在风险并给予同意。尽管缺乏证据表明一小部分患者是否可以从联合治疗中受益，但是尽管有足够的左甲状腺素单药治疗但仍对症治疗的患者可能需要进行试验。这应由具有丰富经验的临床医生进行，并在短期和长期内适当监测不良结果。

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