Objective To observe the clinical results and changes in TSH , FT3 , FT4 , TPOAb and TGAb of patients with hypothyroidism in treatment with levothyroxine and selenium supplement .Methods Ninety-two cases of patients with hypothyroidism were selected , which were treated in hospital from March 2015 to March 2016 , and they were divided into the observation group (46 cases) and control group (46 cases).The patients of control group were treated with levothyroxine tab-lets ( an initial dose of 25 μg, 1 time /d, dose adjustment after two weeks of continuous treatment , increasing 25μg each time, until the optimum effect ) .On the basis of control group , the patients of observation group were treated with selenium yeast tablets (50 μg, orally, 2 times /d).The patients of two groups were all treated for 6months.Compare the clinical effi-cacy and changes of the levels of free three triiodothyronine ( FT3 ) , free four triiodothyronine ( FT4 ) , thyroid stimulating hor-mone (TSH), thyroid peroxidase antibody ( TPOAb), thyroglobulin antibody ( TGAb), high density lipoprotein protein (HDL-C), low density lipoprotein (LDL-C), total cholesterol (TC), triglyceride (TG) of two groups.Results After the appropriate treatment , the patients of the observation group got a total effective rate of 95 .7%, which was significantly better than the 82.6%of the control group (χ2 =4.039, P =0.044);In the terms of TSH, TPOAb, TGAb, LDL-C,TC and TG, the patients of two groups were all significantly decreased than before (observation group:t =45.159, t =6.243, t =9.266, t =17.969, t =17.146, t =17.669,control group:t =44.144, t =3.971, t =7.168, t =12.415, t =9.402, t =10.621, P <0.05), and the patients of the observation group got more significant decline ( t =1.896, t =2.685, t =2.061, t =7.058, t =10.636, t =8.724, P <0.05); In the terms of FT3,the patients of two groups were all significantly increased than before (observation group:t =14.524, t =7.673,control group:t =12.723, t =5.903, P <0.05), and in the terms of FT3 ,the patients of the observation group got more significant increase ( t =2.151, P <0.05);there were headache , gas-trointestinal discomfort, chest tightness, tachycardia, allergic reactions and other adverse reactions occurred in both two groups, but there were no statistically significant between the two groups (χ2 =1.170,χ2 =0.474,χ2 =0.000,χ2 =1.593,χ2 =2.224, P >0.05).Conclusion With treating patients with hypothyroidism , levothyroxine and selenium supplement can significantly improve the clinical efficacy , effectively improve the levels of thyroid and autoantibodies , and it is also safe and reliable, which makes it worthy of promotion .%目的：观察左甲状腺素钠联合补硒治疗甲状腺功能减退的临床疗效及对促甲状腺激素（ TSH）、游离三碘甲状腺原氨酸（ FT3）、游离四碘甲状腺原氨酸（ FT4）、甲状腺过氧化物酶抗体（ TPOAb ）、甲状腺球蛋白抗体（ TGAb）的影响。方法选取2015年3月—2016年3月辽宁省金秋医院内分泌代谢科收治的甲状腺功能减退患者92例作为研究对象，按随机数字表法随机分为对照组46例和观察组46例。对照组给予左甲状腺素片，初始剂量25μg，1次／d，连续治疗2周后调整1次剂量，每次增加剂量25μg，直至达到最佳疗效；观察组在对照组基础上联合应用硒酵母片50μg口服，2次／d。2组患者连续治疗6个月。比较2组患者临床疗效，检测患者治疗前后FT3、FT4、TSH、TPOAb、TGAb、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）、总胆固醇（TC）、三酰甘油（TG）水平，并记录不良反应。结果观察组总有效率为95．7％，显著高于对照组的82．6％（χ2＝4．039， P ＝0．044）。治疗后2组患者TSH、TPOAb、TGAb、LDL-C、TC、TG水平均明显降低， FT3、FT4显著升高，与治疗前比较差异具有统计学意义（t观＝45．159、6．243、9．266、17．969、17．146、17．669、14．524、7．673， t 对＝44．144、3．971、7．168、12．415、9．402、10．621、12．723，5．903， P ＜0．05）；其中观察组TSH、TPOAb、TGAb、LDL-C、TC、TG显著低于对照组，FT3明显高于对照组（ t ＝1．896、2．685、2．061、7．058、10．636、8．724、2．151， P ＜0．05），而HDL-C、FT4水平差异无统计学意义（ P ＞0．05）。2组患者治疗期间均发生头痛、胃肠不适、胸闷、心动过速、过敏反应等不良症状，但差异无统计学意义（χ2＝1．170、0．474、0．000、1．593、2．224， P ＞0．05）。结论左甲状腺素钠联合补硒治疗甲状腺功能减退能够显著提高甲状腺功能减退疗效，有效改善甲状腺及自身抗体水平，安全可靠，值得临床推广。
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