Einfluss der Schilddrüsenfunktion auf das Körpergewicht

Zusammenfassung

Sehr viele Übergewichtige sind der Meinung, dass ihre Gewichtsveränderungen ursächlich auf Störungen der Schilddrüsenfunktion zurückzuführen sind.

De facto sind aber die Einflüsse von Schilddrüsenfunktionsstörungen auf das Gewicht weitgehend ungeklärt.

Deshalb sollen die Zusammenhänge verlässlich über eine systematische Literatursuche und Bewertung geklärt werden.

Nach systematischen Übersichtsarbeiten wurden die Cochrane Library, NHSCRD (Centre for Reviews and Dissemination, York), Medline und Clinical Evidence durchsucht, aktuelle evidenzbasierte Leitlinien sind erfasst (GIN.net). Nach randomisierten kontrollierten Studien (RCTs) wurde in PubMED, EMBASE und CENTRAL der Cochrane Library gesucht. Die Methodik orientiert sich an den Cochrane-Gruppen.

Die klinisch manifeste Schilddrüsenunterfunktion führt zu einer Gewichtszunahme. Sie wird mit dem Empfehlungsgrad A mit Levothyroxin behandelt. Wissenschaftlich gibt es dazu keine Alternative, weitere Studien wären unethisch. Die Hyperthyreose führt zur Gewichtsabnahme.

Zur subklinischen Hypothyreose und zur subklinischen Hyperthyreose finden sich weltweit nicht ausreichend verlässliche Studien um sicher auszusagen, dass ein Einfluss auf das Gewicht gegeben ist. Viel bleibt Spekulation, viele Menschen werden überbehandelt.

Abstract

Many patents with weight problems believe they are caused by thyroidal dysfunction. In contrast, the influences of thyroidal dysfunction on body weight are not well documented.

Therefore this work was done to evaluate systematically the possible connection of weight changes and thyroid function.

The following databases were used to identify systematic reviews: Medline to November 2014, Embase and The Cochrane Database of Systematic Reviews. Additional searches were carried out in the Database of Abstracts of Reviews of Effects (DARE) and the Health Technology Assessment (HTA) Database and in GIN.net for guidelines. We also searched Medline, Embase, and CENTRAL (Cochrane Library) for RCTs. We used the search strategy of the Cochrane Collaboration.

Clinical (overt) hypothyroidism leads to weight gain. Levothyroxine is beneficial in clinical hypothyroidism (GRADE A recommendation) and the treatment of choice.

A placebo-controlled trial would be considered unethical.

Clinical hyperthyroidism causes weight loss.

Our search does not yield enough RCTs to evaluate possible influences of subclinical hypothyroidism/hyperthyroidism on bodyweight. Many recommendations are not evidence based and this may lead to overtreatment.

Schlüsselwörter

Gewicht - Adipositas - Hyperthyreose - Hypothyreose - Autoimmunthyreoiditis - systematische Übersicht

Keywords

body weight - obesity - hyperthyroidism - hypothyroidism - Hashimoto's thyroiditis - systematic review

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