自身免疫性甲状腺炎:治疗可能性的最新进展。

Kamil Dyrka, Monika Obara-Moszyńska, Marek Niedziela
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引用次数: 0

摘要

自身免疫性甲状腺炎(AIT)是由于自身免疫过程破坏了甲状腺细胞,从而导致内分泌紊乱。自体免疫性甲状腺炎多见于女性,病因是多因素的。甲状腺细胞受到破坏后会向血液中释放游离甲状腺激素,从而引起甲状腺功能亢进症状。随着甲状腺细胞的进一步破坏,患者会出现甲状腺功能减退,最终发展为慢性甲状腺功能减退。AIT 的诊断依据是临床症状、抗甲状腺抗体阳性、超声波检查和组织学特征。治疗的主要目标是纠正内分泌紊乱,实现甲状腺功能亢进。AIT 的治疗包括使用合成激素来补充甲状腺激素的不足。对甲状腺功能正常的AIT患者进行预防性左甲状腺素(L-T4)治疗可降低自身免疫的血清学和细胞标记物。应注意左旋甲状腺素(L-T4)的起始剂量、潜在的药物相互作用和药物配方。应计划进行随访,以确定最佳剂量。作者强调,健康的生活方式以及适当补充某些维生素和微量元素至关重要。在特定的临床条件下,应考虑进行甲状腺切除术。此外,还有一些替代治疗策略,如草药和针灸,但其有效性还有待研究的最终证实。监测甲状腺肿大和结节性甲状腺肿发展的可能性是 AIT 患者护理不可或缺的一部分。总之,AIT的治疗非常复杂,涉及甲状腺激素替代疗法、健康的饮食和生活方式以及适当的营养补充。治疗需要因人而异。为了控制病情并将其影响降至最低,有必要进行定期随访。
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Autoimmune thyroiditis: an update on treatment possibilities.

Autoimmune thyroiditis (AIT) is due to an autoimmune process that destroys thyrocytes, leading to hormonal disorders. AIT is more common in women, and the aetiology is multifactorial. The destruction of thyroid cells may release free thyroid hormones into the bloodstream, causing hyperthyroid symptoms. With further destruction of thyroid cells, patients develop euthyroidism and eventually chronic hypothyroidism. The diagnosis of AIT is based on clinical symptoms, positive anti-thyroid antibodies, ultrasound, and histological features. The main goal of treatment is correcting hormonal disorders and achieving euthyroidism. Treatment of AIT involves replacing thyroid hormone deficiency with the use of synthetic hormones. Prophylactic levothyroxine (L-T4) treatment of euthyroid patients with AIT may reduce both serological and cellular markers of autoimmunisation. Attention should be paid to the starting dose of L-T4, potential drug interactions, and drug formulation. A follow-up should be planned to determine the optimal dose. The authors highlighted that a healthy lifestyle and supplementing selected vitamins and microelements appropriately are essential. In selected clinical conditions, thyroidectomy should be considered. There are also alternative therapeutic strategies, such as herbal medicine and acupuncture, but their effectiveness has yet to be conclusively confirmed in research studies. Monitoring the thyroid gland enlargement and the possibility of developing nodular goitre is integral to patient care over AIT patients. In conclusion, treating AIT is complex, involving thyroid hormone replacement therapy, taking care of a healthy diet and lifestyle, and proper supplementation. It requires an individual approach. Regular follow-up is necessary to control the disease and minimise its effects.

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