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目的 观察不同剂量左旋甲状腺素钠(L-T_4)治疗先天性甲状腺功能减低症的临床效果,探讨早期干预治疗的适宜剂量。方法 将108例新生儿确诊后随机分为2组,每组各54例,经专科医师对患儿家长进行基本知识教育后,行L-T_4替代治疗。大剂量组10.1～15.0μg·kg~(-1)·d~(-1),小剂量组6.0～10.0μg·kg~(-1)·d~(-1),三碘甲状腺原氨酸(T_3)、甲状腺素(T_4)、促甲状腺激素(TSH)恢复正常后改为维持量1.0～4.0μg·kg~(-1)·d~(-1)。随访观察2组患儿身高、体重、头围的发育状况及T_1、T_4、TSH的动态变化特点。结果 108例患儿经过替代治疗后临床症状迅速好转,生长发育加快。治疗1个月时,两组患儿T_3均正常;T_4值未恢复正常的大剂量组6例,小剂量组16例,两组比较差异有显著性;TSH值未恢复正常的大剂量组22例,小剂量组39例,两组比较差异有显著性。动态观察发现患儿3个月时,大剂量组患儿平均体重高于小剂量组。结论 L-T_4 10.1～15μ·kg~(-1)·d~(-1)早期干预治疗先天性甲状腺功能减低症能较快纠正患儿的甲状腺功能,避免先天性甲状腺功能减低症患儿发生智能发育异常。
Objective To observe the clinical effects of different doses of L-T_4 in the treatment of congenital hypothyroidism (Hypothyroidism) and to explore the appropriate dose of early intervention. Methods One hundred and eight newborns were randomly divided into two groups (54 cases in each group). After the basic knowledge education for the parents of the children was carried out by the specialist, L-T_4 replacement therapy was performed. 10.1 ~ 15.0μg · kg -1 · d -1 in the high-dose group and 6.0-10.0μg · kg -1 · d -1 in the low-dose group. The levels of triiodothyronine (T_3), thyroxine (T_4) and thyroid stimulating hormone (TSH) returned to normal after maintenance dose 1.0 ~ 4.0μg · kg -1 · d -1. Follow-up was observed in two groups of children’s height, weight, head circumference of the development status and T 1, T 4, TSH dynamic changes. Results After treatment, the clinical symptoms of 108 children improved rapidly and their growth accelerated. After treatment for 1 month, T_3 in both groups were normal; 6 cases in high dose group and 16 cases in low dose group did not return to normal, the difference was significant between the two groups; Cases, low-dose group of 39 cases, the difference between the two groups was significant. Dynamic observation found that children with 3 months, the average weight of children in high-dose group was higher than the low-dose group. Conclusion Early treatment of congenital hypothyroidism with 10.1 ~ 15μ · kg ~ (-1) · d -1 L-T 4 can quickly correct the thyroid function of children and avoid congenital hypothyroidism Intelligent developmental abnormalities.