Download The Study: （研究效度）

中醫科
實證期刊閱讀報告
EBM-style Journal Reading
報告人： 黃香慈
Email:[email protected]
指導臨床教師：黃頌儼
日期：101/ 11 / 12
地點：中醫臨床技能中心
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。
2
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？
3
臨床個案的PICO
Patient / Problem
hypothyroidism; obesity
Intervention
levothyroxine
levothyroxine; L-T4
therapy
Comparison
none
Outcome
regain
Type of Question: Prognosis
4
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
5
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.
6
The Study: （研究效度）- 1
 The author review several of the most
recent 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
7
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
8
Abstract
 Body weight regulation after treatment
was studied in 87 hyperthyroid and 18
hypothyroid subjects.
9
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
10
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.
11
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、
12
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
13
References:
 1. Hoogwerf BJ, Nuttall FQ. Long-term weight
regulation 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.
14
 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.
15
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
16
17