References

transmed

Трансляционная медицина

Translational Medicine

2311-44952410-5155

Almazov National Medical Research Centre, Saint Petersburg, Russia

10.18705/2311-4495-2023-10-3-209-222

transmed-853

Research Article

СЕРДЕЧНО-СОСУДИСТЫЕ ЗАБОЛЕВАНИЯ

CARDIOVASCULAR MEDICINE

ОСОБЕННОСТИ ТЕЧЕНИЯ КАРДИОВАСКУЛЯРНОЙ ПАТОЛОГИИ НА ФОНЕ СУБКЛИНИЧЕСКОГО ГИПОТИРЕОЗА

PECULIARITIES OF THE COURSE OF CARDIOVASCULAR PATHOLOGY IN SUBCLINICAL HYPOTHYROIDISM

Кузнецова

О. Е.

Kuznetsova

O. E.

Кузнецова Олеся Евгеньевна, клинический ординатор

ул. Академика Лебедева, д. 6, Санкт-Петербург, 194044

Olesya E. Kuznetsova, resident

Akademika Lebedeva str., 6, Saint Petersburg, 194044

Кружалин

Е. Е.

Kruzhalin

E. E.

Кружалин Егор Евгеньевич, слушатель ординатуры

ул. Академика Лебедева, д. 6, Санкт-Петербург, 194044

Egor E. Kruzhalin, resident

Akademika Lebedeva str., 6, Saint Petersburg, 194044

gogil01@mail.ru

Кутелев

Г. Г.

Kutelev

G. G.

Кутелев Геннадий Геннадьевич, к.м.н., старший преподаватель кафедры Военно-морской терапии

ул. Академика Лебедева, д. 6, Санкт-Петербург, 194044

Gennady G. Kutelev, MD, PhD, Senior Lecturer, Department of Naval therapy

Akademika Lebedeva str., 6, Saint Petersburg, 194044

Черкашин

Д. В.

Cherkashin

D. V.

Черкашин Дмитрий Викторович, д.м.н., профессор, заслуженный врач РФ, начальник кафедры Военно-морской терапии

ул. Академика Лебедева, д. 6, Санкт-Петербург, 194044

Dmitry V. Cherkashin, MD, PhD, DSс, Professor, Honored Doctor of the Russian Federation, Head of the Department of Naval therapy

Akademika Lebedeva str., 6, Saint Petersburg, 194044

Никашин

А. Н.

Nikashin

A. N.

Никашин Алексей Николаевич, к.м.н., преподаватель кафедры Военно-морской терапии

ул. Академика Лебедева, д. 6, Санкт-Петербург, 194044

Alexey N. Nikashin, MD, PhD, Lecturer, Department of Naval therapy

Akademika Lebedeva str., 6, Saint Petersburg, 194044

Федеральное государственное бюджетное военное образовательное учреждение высшего образования «Военно-медицинская академия имени С. М. Кирова» Министерства обороны Российской ФедерацииРоссияMilitary Medical Academy named after S. M. KirovRussian Federation

2023

26082023

103209222

2023

Кузнецова О.Е., Кружалин Е.Е., Кутелев Г.Г., Черкашин Д.В., Никашин А.Н.

Kuznetsova O.E., Kruzhalin E.E., Kutelev G.G., Cherkashin D.V., Nikashin A.N.

Данная работа распространяется под лицензией Creative Commons Attribution 4.0.

This work is licensed under a Creative Commons Attribution 4.0 License.

https://transmed.almazovcentre.ru/jour/article/view/853

Первичный гипотиреоз — одна из самых распространенных эндокринных патологий. Выделяют две формы гипотиреоза: манифестную и субклиническую. Субклинический гипотиреоз (СГ) — распространенное заболевание, диагностируемое при повышенном уровне тиреотропного гормона (ТТГ) и нормальном уровне свободного тироксина (Т4) сыворотки крови. Актуальность проблемы обусловлена также трудностями диагностики СГ в связи с его малосимптомным или асимптомным течением и многочисленными «масками»: кардиологическими, гастроэнтерологическими, ревматологическими, гематологическими, психиатрическими. Большое разнообразие причин развития гипотиреоза также затрудняет своевременную диагностику.Имеется множество исследований, доказывающих влияние СГ на состояние сердечно-сосудистой системы (ССС) и его ассоциацию с более высоким риском сердечно-сосудистых событий. Частой сердечной аномалией, наблюдаемой при СГ, является диастолическая дисфункция и артериальная гипертензия (АГ) преимущественно диастолического характера. При этом вопрос о назначении заместительной терапии Левотироксином натрия все еще остается спорным. Отсутствие общепринятых рекомендаций делает необходимым проведение дальнейших исследований в области данной проблемы для разработки единых алгоритмов по лечению пациентов с СГ, в том числе с сопутствующими сердечно-сосудистыми заболеваниями (ССЗ).ССЗ является частым спутником гипотиреоза. При этом все исследования в отношении заместительной терапии СГ имеют низкое методологическое качество, и их выводы по интересующим исходам не являются согласованными, вследствие чего требуются дальнейшие исследования с большим числом пациентов для выявления влияния СГ на состояние сердечно-сосудистой системы.В настоящем обзоре авторами обобщены и представлены имеющиеся данные о частоте распространения, патогенетических механизмах, сердечно-сосудистой патологии при СГ, а также его лечении.

Primary hypothyroidism is one of the most common endocrine pathologies. Subclinical hypothyroidism (SH) is a common disorder diagnosed with elevated levels of thyroid-stimulating hormone (TSH) and normal serum free thyroxine (T4) levels. There are also the difficulties in diagnosing SH due to its low-symptomatic or asymptomatic course and numerous “masks”: cardiological, gastroenterological, rheumatological, hematological, psychiatric. A wide variety of causes also makes timely diagnosis difficult.There are many studies proving the effect of SH on the state of the cardiovascular system (CVS) and its association with a higher risk of cardiovascular events. Diastolic dysfunction and arterial hypertension (AH) are commonly observed. Of note, the issue of prescribing replacement therapy with Levothyroxine sodium is still controversial. It is necessary to conduct further research in order to develop unified algorithms for the treatment of patients with FH, including those with concomitant cardiovascular diseases (CVD).CVD is a frequent companion of hypothyroidism. The studies on FH replacement therapy are of low methodological quality and their conclusions on the outcomes of interest are not consistent. Thus, further studies with a large number of patients are required to identify the effect of FH on the state of the CVS.In this review, the authors summarize and present the available data on the incidence, pathogenetic mechanisms, cardiovascular pathology in HF, as well as its treatment.

артериальная гипертензиядиастолическая дисфункциязаместительная терапияЛевотироксин натриясердечная недостаточностьсубклинический гипотиреоз

arterial hypertensiondiastolic dysfunctionheart failurereplacement therapysodium levothyroxinesubclinical hypothyroidism

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