Международный эндокринологический журнал Том 20, №2, 2024

Дисфункція щитоподібної залози (ЩЗ) — частий ендокринний розлад у загальній популяції, поширеність якого становить 10–15 %. Цей показник вищий у літніх людей: за оцінками, поширеність тиреоїдних дисфункцій становить 25 % у деяких популяціях. Оскільки пацієнти похилого віку зазвичай мають більше супутніх захворювань, ніж люди молодшого віку, дисфункція ЩЗ може мати синергічний негативний вплив на здоров’я, головним чином через підвищений ризик виникнення серцево-судинних захворювань. Дисфункцію ЩЗ в осіб похилого віку іноді важче діагностувати внаслідок невираженої або навіть безсимптомної клінічної картини, а на інтерпретацію тестів функціонального стану ЩЗ можуть вплинути інші препарати за умов лікування коморбідних станів. Клінічний досвід показує, що літні люди з гіпертиреозом мають менше ознак або симптомів порівняно з молодими пацієнтами з гіпертиреозом. Крім того, в осіб похилого віку з нормальними показниками функції ЩЗ спостерігаються клінічні ознаки гіпотиреозу. Результати досліджень свідчать про те, що може існувати вікова резистентність до дії тиреоїдних гормонів. Експериментальні роботи вказують на пов’язане з віком зниження реакції на екзогенне введення гормонів ЩЗ. Цю стійкість до дії тиреоїдних гормонів пояснюють їх зниженим клітинним транспортом. Епідеміологічні дослідження підтверджують, що діагностика та лікування захворювань ЩЗ у літніх людей відрізняються від поточних рекомендацій щодо лікування молодих людей із тиреоїдними захворюваннями. Слід зазначити, що вікова резистентність до гормонів ЩЗ відрізняється від вроджених синдромів резистентності до тиреоїдних гормонів. Ця відмінність пояснюється віковими змінами чутливості гіпофіза до гальмування тиреоїдними гормонами за принципом зворотного зв’язку і зниженням реакції ЩЗ на тиреотропний гормон. Сучасні дані свідчать про те, що вікова резистентність до гормонів ЩЗ є адаптивним процесом для подовження тривалості життя. У цій оглядовій статті узагальнені сучасні відомості щодо патофізіології, діагностики та терапевтичного лікування дисфункції ЩЗ у пацієнтів похилого віку.

Thyroid dysfunction is a common endocrine disorder in the general population, with a reported prevalence of 10–15 %. This rate is higher in older adults, with an estimated prevalence of 25 % in some populations. Since elderly patients usually present more comorbidities than younger individuals, thyroid dysfunction may carry a synergistic negative health impact, mainly due to increased cardiovascular disease risk. Thyroid dysfunction in the elderly can be more difficult to diagnose due to its subtle or even asymptomatic clinical presentation, and the interpretation of thyroid function tests may be affected by drugs that interfere with thyroid function or by the coexistence of several diseases. Clinical experience shows that older people with hyperthyroidism display fewer signs or symptoms compared to younger people with hyperthyroidism. Moreover, older people with normal thyroid function tests have several clinical features of hypothyroidism. These observations suggest that there may be an age-related resistance to the actions of thyroid hormones. Laboratory experiments have consistently documented an age-related blunting of response to exogenously administered thyroid hormones. This resistance to thyroid hormones action has been attributed to reduced cellular transport of thyroid hormones. In light of these observations, along with epidemiologic studies, the diagnosis and treatment of thyroid disease in older people differ from the current treatment guidelines of younger people with thyroid disease. It is noteworthy that the age-related resistance to thyroid hormones is distinct from the congenital thyroid hormone resistance syndromes. This distinction is explained by the age-related changes in pituitary responsiveness to the feedback inhibition by thyroid hormones and reduced thyroid gland response to thyrotropin. The current evidence suggests that the age-related resistance to thyroid hormones is an adaptive process to prolong life span. In this review article, we summarize the current knowledge on the pathophysiology, diagnosis, and therapeutic management of thyroid dysfunction in elderly patients.

субклінічний гіпотиреоз; явний гіпотиреоз; гіпертиреоз; люди похилого віку; надмірне лікування; скринінг

subclinical hypothyroidism; overt hypothyroidism; hyperthyroidism; elderly; overtreatment; screening

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