endofocusFOCUS ЭндокринологияFOCUS. Endocrinology2713-01772713-0185ООО "Издательство "Перо"10.62751/2713-0177-2025-6-3-08endofocus-169Research ArticleОБЗОР ЛИТЕРАТУРЫLITERATURE REVIEWПроблема гипотиреоза сегодня: актуальные задачи и решенияThe problem of hypothyroidism today: Current challenges and solutionshttps://orcid.org/0000-0001-9007-4123БирюковаЕ. В.BiryukovaE. V.

Бирюкова Елена Валерьевна – д.м.н., профессор эндокринологии 

г. Москва

Elena V. Biryukova – D. Sci (Med.), professor of the Department of endocrinology

Moscow

 

 

lena@obsudim.ruhttps://orcid.org/0000-0001-6388-1544ПлатоноваН. М.PlatonovaN. M.

Платонова Надежда Михайловна – д.м.н., заведующая отделом терапевтической эндокринологии 

г. Москва

Nadezhda M. Platonova – D. Sci (Med.), Head of the Department of therapeutic endocrinology 

Moscow

doc-platonova@inbox.ruhttps://orcid.org/0000-0003-1548-1487ШинкинМ. В.ShinkinM. V.

Михаил Викторович Шинкин – научный сотрудник отдела эндокринных и метаболических заболеваний, врач-эндокринолог 

г. Москва

Mikhail V. Shinkin – Researcher at the Department of endocrine and metabolic diseases, endocrinologist

 Moscow

 

m.shinkin@mknc.ruФГБОУ ВО «Российский университет медицины» Минздрава РоссииRussian University of MedicineФГБУ «Национальный медицинский исследовательский центр эндокринологии им. И.И. Дедова» Минздрава РоссииNational Medical Research Center for EndocrinologyГБУЗ «Московский клинический научный центр им. А.С. Логинова Департамента здравоохранения города Москвы»A.S. Loginov Moscow Clinical Research Center202513112025635966Copyright © Бирюкова Е.В., Платонова Н.М., Шинкин М.В., 20252025Бирюкова Е.В., Платонова Н.М., Шинкин М.В.Biryukova E.V., Platonova N.M., Shinkin M.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://endofocus.elpub.ru/jour/article/view/169

Гипотиреоз - клинический синдром, формирующийся вследствие снижения функции щитовидной железы, что проявляется уменьшением уровня тиреоидных гормонов в крови. Частота выявления гипотиреоза зависит от пола и возраста пациента. В статье рассматриваются ключевые причины первичного и вторичного гипотиреоза. Основным фактором, вызывающим первичный гипотиреоз, является аутоиммунный тиреоидит, который может возникать как изолированно, так и в сочетании с другими аутоиммунными патологиями. Степень выраженности клинических проявлений зависит от степени дефицита тиреоидных гормонов. Подробно описана симптоматика гипотиреоза, с упором на патологические изменения сердечно-сосудистой системы. Гипотиреоз наиболее часто встречается у пожилых пациентов и людей старческого возраста, характерной особенностью у которых является смазанная клиническая картина заболевания. Отдельное внимание уделено трудностям диагностики гипотиреоза, который иногда маскируется под симптомы других заболеваний. Подтверждение диагноза требует проведения комплекса лабораторных и инструментальных исследований. Лечение гипотиреоза, независимо от его причины, осуществляется с использованием заместительной терапии натрием левотироксина (L-T4). Предложены рекомендации по оптимизации подходов к терапии при тиреоидной недостаточности.

Hypothyroidism is a clinical syndrome resulting from decreased thyroid function, manifested by decreased thyroid hormone levels in the blood. The incidence of hypothyroidism varies by gender and age. This article examines the key causes of primary and secondary hypothyroidism. The main factor causing primary hypothyroidism is autoimmune thyroiditis, which can occur in isolation or in combination with other autoimmune pathologies. The severity of clinical manifestations depends on the degree of thyroid hormone deficiency. The symptoms of hypothyroidism are described in detail, with an emphasis on pathological changes in the cardiovascular system. Hypothyroidism is most common in elderly patients and the elderly, who are characterized by a vague clinical picture. Special attention is given to the difficulties of diagnosing hypothyroidism, which sometimes masquerades as symptoms of other diseases. Confirmation of the diagnosis requires a range of laboratory and instrumental studies. Hypothyroidism, regardless of its cause, is treated with sodium levothyroxine (L-T4) replacement therapy. Recommendations for optimizing treatment approaches for thyroid insufficiency are provided.

гипотиреозтиреоидные гормонытиреотропный гормонзаместительная терапиялевотироксин натрия (L-T4)hypothyroidismthyroid hormonesthyroid-stimulating hormonereplacement therapylevothyroxine sodium (L-T4)ReferencesTaylor PN, Medici MM, Hubalewska-Dydejczyk A, Boelaert K. Hypothyroidism. Lancet. 2024;404(10460):1347–64. doi: 10.1016/S0140-6736(24)01614-3.Taylor PN, Medici MM, Hubalewska-Dydejczyk A, Boelaert K. Hypothyroidism. Lancet. 2024;404(10460):1347–64. doi: 10.1016/S0140-6736(24)01614-3.Garmendia Madariaga A, Santos Palacios S, Guillen-Grima F., Galofre JC. The incidence and prevalence of thyroid dysfunction in Europe: A meta-analysis. J Clin Endocrinol Metab. 2014;99(3):923–31. doi: 10.1210/jc.2013-2409.Garmendia Madariaga A, Santos Palacios S, Guillen-Grima F., Galofre JC. The incidence and prevalence of thyroid dysfunction in Europe: A meta-analysis. J Clin Endocrinol Metab. 2014;99(3):923–31. doi: 10.1210/jc.2013-2409.Benvenga S, Papi G, Antonelli A. Refractory hypothyroidism due to improper storage of levothyroxine tablets. Front Endocrinol (Lausanne). 2017;8:155. doi: 10.3389/fendo.2017.00155.Benvenga S, Papi G, Antonelli A. Refractory hypothyroidism due to improper storage of levothyroxine tablets. Front Endocrinol (Lausanne). 2017;8:155. doi: 10.3389/fendo.2017.00155.Calsolaro V, Niccolai F, Pasqualetti G, Tognini S, Magno S, Riccioni T et al. Hypothyroidism in the elderly: Who should be treated and how? J Endocr Soc. 2018;3(1):146–58. doi: 10.1210/js.2018-00207.Calsolaro V, Niccolai F, Pasqualetti G, Tognini S, Magno S, Riccioni T et al. Hypothyroidism in the elderly: Who should be treated and how? J Endocr Soc. 2018;3(1):146–58. doi: 10.1210/js.2018-00207.Cooper DS, Biondi B. Subclinical thyroid disease. Lancet. 2012;379(9821):1142– 54. doi: 10.1016/S0140-6736(11)60276-6.Cooper DS, Biondi B. Subclinical thyroid disease. Lancet. 2012;379(9821):1142– 54. doi: 10.1016/S0140-6736(11)60276-6.Yoo WS, Chung HK. Subclinical hypothyroidism: Prevalence, health impact, and treatment landscape. Endocrinol Metab (Seoul). 2021;36(3):500–13. doi: 10.3803/EnM.2021.1066.Yoo WS, Chung HK. Subclinical hypothyroidism: Prevalence, health impact, and treatment landscape. Endocrinol Metab (Seoul). 2021;36(3):500–13. doi: 10.3803/EnM.2021.1066.Mendes D, Alves C, Silverio N, Batel Marques F. Prevalence of undiagnosed hypothyroidism in Europe: A systematic review and meta-analysis. Eur Thyroid J. 2019;8(3):130–43. doi: 10.1159/000499751.Mendes D, Alves C, Silverio N, Batel Marques F. Prevalence of undiagnosed hypothyroidism in Europe: A systematic review and meta-analysis. Eur Thyroid J. 2019;8(3):130–43. doi: 10.1159/000499751.Thiruvengadam S, Luthra P. Thyroid disorders in elderly: A comprehensive review. Dis Mon. 2021;67(11):101223. doi: 10.1016/j.disamonth.2021.101223.Thiruvengadam S, Luthra P. Thyroid disorders in elderly: A comprehensive review. Dis Mon. 2021;67(11):101223. doi: 10.1016/j.disamonth.2021.101223.Chaker L, Bianco AC, Jonklaas J, Peeters RP. Hypothyroidism. Lancet. 2017;390(10101):1550–62. doi: 10.1016/S0140-6736(17)30703-1.Chaker L, Bianco AC, Jonklaas J, Peeters RP. Hypothyroidism. Lancet. 2017;390(10101):1550–62. doi: 10.1016/S0140-6736(17)30703-1.Taylor PN, Iqbal A, Minassian C, Sayers A, Draman MS, Greenwood R et al. Falling threshold for treatment of borderline elevated thyrotropin levels-balancing benefi and risks: Evidence from a large community-based study. JAMA Intern Med. 2014;174(1):32–39. doi: 10.1001/jamainternmed.2013.11312.Taylor PN, Iqbal A, Minassian C, Sayers A, Draman MS, Greenwood R et al. Falling threshold for treatment of borderline elevated thyrotropin levels-balancing benefi and risks: Evidence from a large community-based study. JAMA Intern Med. 2014;174(1):32–39. doi: 10.1001/jamainternmed.2013.11312.Фадеев В.В., Моргунова Т.Б., Мельниченко Г.А., Дедов И.И. Проект клинических рекомендаций по гипотиреозу. Клиническая и экспериментальная тиреоидология. 2021;17(1):4–13. doi: 10.14341/ket12702.Фадеев В.В., Моргунова Т.Б., Мельниченко Г.А., Дедов И.И. Проект клинических рекомендаций по гипотиреозу. Клиническая и экспериментальная тиреоидология. 2021;17(1):4–13. doi: 10.14341/ket12702.Verloop H, Louwerens M, Schoones JW, Kievit J, Smit JW, Dekkers OM. Risk of hypothyroidism following hemithyroidectomy: Systematic review and metaanalysis of prognostic studies. J Clin Endocrinol Metab. 2012;97(7):2243–55. doi: 10.1210/jc.2012-1063.Verloop H, Louwerens M, Schoones JW, Kievit J, Smit JW, Dekkers OM. Risk of hypothyroidism following hemithyroidectomy: Systematic review and metaanalysis of prognostic studies. J Clin Endocrinol Metab. 2012;97(7):2243–55. doi: 10.1210/jc.2012-1063.Roberts CG, Ladenson PW. Hypothyroidism. Lancet. 2004;363(9411):793–803. doi: 10.1016/S0140-6736(04)15696-1.Roberts CG, Ladenson PW. Hypothyroidism. Lancet. 2004;363(9411):793–803. doi: 10.1016/S0140-6736(04)15696-1.Wang Z, Wang H, Bu C, Meng B, Mu Y, Gao S et al. Tyrosine kinase inhibitor-induced hypothyroidism: Mechanism and clinical implications. Eur J Clin Pharmacol. 2024;80(6):827–38. doi: 10.1007/s00228-024-03626-4.Wang Z, Wang H, Bu C, Meng B, Mu Y, Gao S et al. Tyrosine kinase inhibitor-induced hypothyroidism: Mechanism and clinical implications. Eur J Clin Pharmacol. 2024;80(6):827–38. doi: 10.1007/s00228-024-03626-4.Rizzo LFL, Mana DL, Serra HA. Drug-induced hypothyroidism. Medicina (B Aires). 2017;77(5):394–404.Rizzo LFL, Mana DL, Serra HA. Drug-induced hypothyroidism. Medicina (B Aires). 2017;77(5):394–404.Laurberg P, Andersen S, Bulow Pedersen I., Carle A. Hypothyroidism in the elderly: Pathophysiology, diagnosis and treatment. Drugs Aging. 2005;22(1):23–38. doi: 10.2165/00002512-200522010-00002.Laurberg P, Andersen S, Bulow Pedersen I., Carle A. Hypothyroidism in the elderly: Pathophysiology, diagnosis and treatment. Drugs Aging. 2005;22(1):23–38. doi: 10.2165/00002512-200522010-00002.Burch HB. Drug effects on the thyroid. N Engl J Med. 2019;381(8):749–61. doi: 10.1056/NEJMra1901214.Burch HB. Drug effects on the thyroid. N Engl J Med. 2019;381(8):749–61. doi: 10.1056/NEJMra1901214.Udovcic M, Pena RH, Patham B, Tabatabai L, Kansara A. Hypothyroidism and the heart. Methodist Debakey Cardiovasc J. 2017;13(2):55–59. doi: 10.14797/mdcj-13-2-55.Udovcic M, Pena RH, Patham B, Tabatabai L, Kansara A. Hypothyroidism and the heart. Methodist Debakey Cardiovasc J. 2017;13(2):55–59. doi: 10.14797/mdcj-13-2-55.Razvi S, Jabbar A, Pingitore A, Danzi S, Biondi B, Klein I et al. Thyroid hormones and cardiovascular function and diseases. J Am Coll Cardiol. 2018;71(16):1781–96. doi: 10.1016/j.jacc.2018.02.045.Razvi S, Jabbar A, Pingitore A, Danzi S, Biondi B, Klein I et al. Thyroid hormones and cardiovascular function and diseases. J Am Coll Cardiol. 2018;71(16):1781–96. doi: 10.1016/j.jacc.2018.02.045.Feldt-Rasmussen U, Effraimidis G, Bliddal S, Klose M. Consequences of under treatment of hypothyroidism. Endocrine. 2023:9;84(2):301–8. doi: 10.1007/s12020-023-03460-1.Feldt-Rasmussen U, Effraimidis G, Bliddal S, Klose M. Consequences of under treatment of hypothyroidism. Endocrine. 2023:9;84(2):301–8. doi: 10.1007/s12020-023-03460-1.Joshi AS, Woolf PD. Pituitary hyperplasia secondary to primary hypothyroidism: A case report and review of the literature. Pituitary. 2005;8(2):99–103. doi: 10.1007/s11102-005-3281-8.Joshi AS, Woolf PD. Pituitary hyperplasia secondary to primary hypothyroidism: A case report and review of the literature. Pituitary. 2005;8(2):99–103. doi: 10.1007/s11102-005-3281-8.Carle A, Pedersen IB, Knudsen N, Perrild H, Ovesen L, Andersen S, Laurberg P. Hypothyroid symptoms fail to predict thyroid insufficiency in old people: A population-based case-control study. Am J Med. 2016;129(10):1082–92. doi: 10.1016/j.amjmed.2016.06.013.Carle A, Pedersen IB, Knudsen N, Perrild H, Ovesen L, Andersen S, Laurberg P. Hypothyroid symptoms fail to predict thyroid insufficiency in old people: A population-based case-control study. Am J Med. 2016;129(10):1082–92. doi: 10.1016/j.amjmed.2016.06.013.Hernando VU, Eliana MS. Role of thyroid hormones in different aspects of cardiovascular system. Endocrinol Metab Synd. 2015;(4-2): 166. doi: 10.4172/2161-1017.1000166.Hernando VU, Eliana MS. Role of thyroid hormones in different aspects of cardiovascular system. Endocrinol Metab Synd. 2015;(4-2): 166. doi: 10.4172/2161-1017.1000166.Boelaert K. Thyroid dysfunction in the elderly. Nat Rev Endocrinol. 2013;9(4):194– 204. doi: 10.1038/nrendo.2013.30.Boelaert K. Thyroid dysfunction in the elderly. Nat Rev Endocrinol. 2013;9(4):194– 204. doi: 10.1038/nrendo.2013.30.Hennessey JV, Espaillat R. Subclinical hypothyroidism: A historical view and shifting prevalence. Int J Clin Pract. 2015;69(7):771–82. doi: 10.1111/ijcp.12619.Hennessey JV, Espaillat R. Subclinical hypothyroidism: A historical view and shifting prevalence. Int J Clin Pract. 2015;69(7):771–82. doi: 10.1111/ijcp.12619.Cappelli C, Rotondi M, Pirola I, Agosti B, Gandossi E, Valentini U et al. TSH-lowering effect of metformin in type 2 diabetic patients: differences between euthyroid, untreated hypothyroid, and euthyroid on L-T4 therapy patients. Diabetes Care. 2009;32(9):1589–90. doi: 10.2337/dc09-0273.Cappelli C, Rotondi M, Pirola I, Agosti B, Gandossi E, Valentini U et al. TSH-lowering effect of metformin in type 2 diabetic patients: differences between euthyroid, untreated hypothyroid, and euthyroid on L-T4 therapy patients. Diabetes Care. 2009;32(9):1589–90. doi: 10.2337/dc09-0273.Sawin CT, Geller A, Wolf PA, Belanger AJ, Baker E, Bacharach P et al. Low serum thyrotropin concentrations as a risk factor for atrial fibrillation in older persons. N Engl J Med. 1994;331(19):1249–52. doi: 10.1056/NEJM199411103311901.Sawin CT, Geller A, Wolf PA, Belanger AJ, Baker E, Bacharach P et al. Low serum thyrotropin concentrations as a risk factor for atrial fibrillation in older persons. N Engl J Med. 1994;331(19):1249–52. doi: 10.1056/NEJM199411103311901.Mammen JS, McGready J, Oxman R, Chia CW, Ladenson PW, Simonsick EM. Thyroid hormone therapy and risk of thyrotoxicosis in community-resident older adults: Findings from the Baltimore Longitudinal Study of Aging. Thyroid. 2015;25(9):979–86. doi: 10.1089/thy.2015.0180.Mammen JS, McGready J, Oxman R, Chia CW, Ladenson PW, Simonsick EM. Thyroid hormone therapy and risk of thyrotoxicosis in community-resident older adults: Findings from the Baltimore Longitudinal Study of Aging. Thyroid. 2015;25(9):979–86. doi: 10.1089/thy.2015.0180.Dedon J. Thyroid disease in aging. Mo Med. 2022;119(4):351–53.Dedon J. Thyroid disease in aging. Mo Med. 2022;119(4):351–53.

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