REPLACEMENT THERAPY OF PRIMARY HYPOTHYROIDISM: MONOTHERAPY WITH L-THYROXINE AND COMBINATION THERAPY OF L-THYROXINE AND TRIIODOTHYRONINE

Аннотация

The prevalence of overt hypothyroidism in the general population is 0.2 - 2%, but in certain groups of the population, in particular, among the elderly, it reaches 15%, so hypothyroidism is one of the most common endocrine diseases. Overt hypothyroidism is an absolute indication for replacement therapy with thyroid hormones. Currently, L-thyroxine monotherapy is mainly used for replacement therapy of hypothyroidism, although studies that would directly compare it with L-T4 + LТЗ combination therapy have been virtually non-existent to date. In recent years, reports have begun to appear in the literature on some advantages of L-T3 + L-T4 combination therapy for hypothyroidism. A number of studies indicate positive dynamics of psychological indicators against the background of L-T4 + L-T3 combination therapy compared to L-T4 monotherapy. On the other hand, some studies have not confirmed the advantages of combination therapy compared to L-T4 monotherapy. Thus, to date, there is no clear data on the possible advantages and disadvantages of combination therapy L-T4 + L-T3 compared to L-T4 monotherapy. It should be noted that, despite the simplicity and convenience of L-T4 monotherapy, some patients, for various reasons, are in a state of chronic decompensation of hypothyroidism, or, despite maintaining a normal TSH level, present complaints characteristic of hypothyroidism, which to some extent may be evidence of the imperfection of this replacement therapy.