problendoПроблемы ЭндокринологииProblems of Endocrinology0375-96602308-1430Endocrinology Research Centre10.14341/probl12471problendo-12471Research ArticleКлиническая эндокринологияClinical endocrinologyИспользование гормонов щитовидной железы в лечении сердечно-сосудистых заболеваний: обзор литературыUse of thyroid hormones in the treatment of cardiovascular diseases: literature reviewhttps://orcid.org/0000-0002-1850-5256БорисовДаниил ВалерьевичBorisovDaniil V.

MD

dborisov.md@gmail.comhttps://orcid.org/0000-0003-3922-2869ГубаеваДиляра НаилевнаGubaevaDiliara N.

аспирант

MD

gubaevadn@gmail.comhttps://orcid.org/0000-0002-9523-5966ПраскурничийЕвгений АркадьевичPraskurnichiyEvgeniy A.

д.м.н., профессор

MD, PhD, Professor

praskurnichey@mail.ruФедеральный медицинский биофизический центр имени А.И. БурназянаРоссияBurnasyan Federal Medical Biophysical CenterRussian FederationНациональный медицинский исследовательский центр эндокринологииРоссияEndocrinology Research CertreRussian FederationРоссийская медицинская академия непрерывного профессионального образованияРоссияRussian Medical Academy of Continuous Professional EducationRussian Federation202016092020663614Copyright © Борисов Д.В., Губаева Д.Н., Праскурничий Е.А., 20202020Борисов Д.В., Губаева Д.Н., Праскурничий Е.А.Borisov D.V., Gubaeva D.N., Praskurnichiy E.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.probl-endojournals.ru/jour/article/view/12471

Сердечно-сосудистые заболевания остаются основной причиной смерти во всем мире. Гормоны щитовидной железы играют значительную роль в регуляции сердечной деятельности. По данным ряда исследований, у пациентов с сердечно-сосудистыми заболеваниями, как правило, отмечается снижение концентрации тиреоидных гормонов в сыворотке крови, что может быть ассоциировано с ухудшением прогноза. До настоящего времени остается неясным вопрос, является ли изменение биодоступности тиреоидных гормонов в миокарде благоприятным физиологическим механизмом или отражением расстройства адаптации. Экспериментальные исследования позволяют выдвинуть предположение, что терапия гормонами щитовидной железы имеет потенциал применения в клинической кардиологии.

В данном обзоре описаны результаты исследований, рассматривающих применение гормонов щитовидной железы у пациентов с сердечно-сосудистыми заболеваниями, а также данные экспериментальных работ на животных моделях. Имеющиеся данные по использованию тиреоидных гормонов у пациентов с острым инфарктом миокарда и сердечной недостаточностью позволяют предположить, что нормализация уровней гормонов щитовидной железы является безопасным и потенциально эффективным методом лечения в группе пациентов с сердечно-сосудистой патологией. Аналогично можно отметить ограниченность данных по использованию тиреоидных гормонов у пациентов, перенесших открытые операции на сердце либо трансплантацию сердца. Тем не менее на текущий момент затруднительно сделать однозначные выводы о пользе, а также о возможном риске применения гормонов щитовидной железы при описанных состояниях. Для подтверждения безопасности и оценки эффективности подобной терапии требуется проведение крупномасштабных клинических исследований. Более того, необходимо задать параметры оценки безопасности и эффективности и понять, какой гормон (тироксин или трийодтиронин), в какой дозировке и на какой стадии заболевания следует вводить. До тех пор, пока не будут даны ответы на поставленные вопросы, терапия тиреоидными гормонами у пациентов с сердечно-сосудистыми заболеваниями должна оставаться в рамках исследовательского поля.

Cardiovascular diseases remain the leading cause of death all over the world. Thyroid hormones play a significant role in the regulation of cardiac function. According to a number of researches, patients with cardiovascular diseases usually have a decrease in the concentration of thyroid hormones in the blood serum, which may be associated with a poor prognosis. Today it still remains unclear whether the change in the bioavailability of thyroid hormones in the myocardium is a favorable physiological mechanism or a replication of an adaptation disorder. Experimental researches suggest that thyroid hormone therapy may be applied in clinical cardiology.

This review describes the results of researches examining the use of thyroid hormones in patients with cardiovascular diseases, as well as experiment data on animal models. The available data on the use of thyroid hormones in patients with acute myocardial infarction and heart failure allow us to suggest that normalization of thyroid hormone levels is a safe and potentially effective treatment method in the group of patients with cardiovascular disease. At the same time, the data on the use of thyroid hormones in patients who have undergone an open-heart surgery or heart transplantation are limited. However, at present, it is difficult to draw unambiguous conclusions about the benefits, as well as about the possible risk of using thyroid hormones in the described conditions. Large-scale clinical researches are required to confirm the safety and evaluate the effectiveness of such therapy. Moreover, it is necessary to set parameters for evaluating the safety and effectiveness and understand which hormone (thyroxine or triiodothyronine), what dosage and at what stage of the disease should be applied. Until we do not have answers for these questions, thyroid hormone therapy in patients with cardiovascular diseases should remain within the research field.

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