中 醫 科實 證 期 刊 閱 讀 報 告EBM-style Journal Reading

報告人： 黃香慈 Email:149348@cch.org.tw

指導臨床教師：黃頌儼日期： 101/ 11 / 12

地點：中醫臨床技能中心

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Clinical Scenario （臨床情境） 48 歲宋女士因肥胖來中醫就診 自述每天飲食三餐無特別食多或高油脂燒烤類食物，平時飲無糖茶類，但無運動習慣。

今年曾服用中藥，三個月內減輕五公斤，但停藥後復胖。

至西醫就診，診斷為橋本氏甲狀腺炎 (Hashimoto‘s thyroiditis) 合併甲狀腺功能低下，給予 levothyroxine(L-T4) 治療中。

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Clinical Uncertainty → PICO 問題

甲狀腺功能低下引起肥胖，使用甲狀腺素治療，停藥後是否會復胖？

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臨床個案的 PICO

Patient / Problem hypothyroidism; obesity

Intervention levothyroxine levothyroxine; L-T4 therapy

Comparison none

Outcome regain

Type of Question: Prognosis

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Search Terms & Strategy: （搜尋關鍵字與策略）

資料庫： Pubmed 搜尋日期： 101.11.07 搜尋關鍵字與隅策略：

#1AddSearch hypothyroidism Obesity levothyroxine153

#2AddSearch hypothyroidism Obesity levothyroxine review 19

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Best available evidence:（挑選可獲得之最佳研究證據）

Citation/s:

Curr Opin Endocrinol Diabetes Obes. 2012 Oct;19(5):408-13

Thyroid hormone and obesity.

Review Lead author's name :

Pearce EN.

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The Study: （研究效度） - 1 The author review several of the most rece

nt and most important clinical studies regarding the effects of thyroid treatments on weight change, associations between thyroid status and weight, and the effects of obesity and weight change on thyroid function.

但文章中沒有提到搜尋方式 由本 Review 文章中找答案

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The Study: （研究效度） - 2

Hoogwerf BJ, Nuttall FQ. Long-term weight regulation in treated hyperthyroid and hypothyroid subjects. Am J Med 1984; 76:963–970

只有摘要 , 無法搜尋到全文 Level of Evidence: 4

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Abstract Body weight regulation after treatment

was studied in 87 hyperthyroid and 18 hypothyroid subjects.

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The Study: （研究效度） - 3本篇文獻的 PICO (T)

Patient / Problem

hyperthyroid and hypothyroid subjects

Intervention hyperthyroid and hypothyroid treatment

Comparison ?

Outcome Long-term weight regulation

Time 1984

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The Evidence: （研究重要結果） - 1

Nine of 18 hypothyroid patients experienced a modest weight loss over the first six months of levothyroxine (L-T4) therapy, but all had returned to their weights before treatment by 12–24 months.

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Comment & Discussion: -1 在其他研究中發現 T4 治療甲狀腺功能減

退症主要是減去體內多餘的水份，對脂肪身體質量沒有影響。

更有研究指出使用 liothyronine (L-T3) 治療會比使用 L-T4 治療在降低體重或者減低脂肪組織上有效、

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回到臨床個案情境Clinical bottom line 臨床決策底線

在甲狀腺低下的病人，醫師會使用 L-T4 治療，只能暫時排除體內多餘水份，使其體重減輕，但無法降低其體脂肪。

證據等級 4

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References: 1. Hoogwerf BJ, Nuttall FQ. Long-term weight re

gulation in treated hyperthyroid and hypothyroid subjects. Am J Med 1984; 76:963–970.

2. Crocker MK, Kaplowitz P. Treatment of paediatric hyperthyroidism but not hypothyroidism has a significant effect on weight. Clin Endocrinol (Oxf) 2010; 73:752–759.

3 Karmisholt J, Andersen S, Laurberg P. Weight loss after therapy of hypothyroidism is mainly caused by excretion of excess body water associated with myxoedema. J Clin Endocrinol Metab 2011; 96:E99–E103.

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4. Boeving A, Paz-Filho G, Radominski RB, et al. Low-normal or high-normal thyrotropin target levels during treatment of hypothyroidism: a prospective, comparative study. Thyroid 2011; 21:355–360.

5.Polotsky HN, Brokhin M, Omry G, et al. Iatrogenic hyperthyroidism does not promote weight loss or prevent ageing-related increases in body mass in thyroid cancer survivors. Clin Endocrinol (Oxf) 2012; 76:582–585.

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結 論 （標題 Title ）

在甲狀腺功能低下的患者，使用 L-T4 不能減少體脂肪。

Kill or Update By （下次更新日期） : Apr. 07, 2013

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