Yıl 2018, Cilt 18, Sayı 2, Sayfalar 235 - 241 2018-06-25

Tedaviye Dirençli Hipotiroidi
Therapy Resistant Hypothyroidism

Oya Topaloğlu [1] , Bekir Çakır [2]

39 58

Hipotiroidi toplumda sık görülen bir problemdir. Hipotiroidinin standart tedavisi sentetik L-tiroksin (L-T4) sodyum preparatları ile replasmandır. Tedavide hedef TSH’yı normal referans değerleri arasında tutmaktır. Beklenen dozların üzerinde L-T4 gereksinimi olan hastalarda altta yatan nedeni tespit etmek zor olabilir. Bu hastalarda öncelikli olarak ilaç alımında uyumsuzluk düşünülmeli ve sonra da altta yatan biyolojik bir neden olup olmadığı da araştırılmalıdır.

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Hypothyroidism is a common problem in the population. Standard therapy for hypothyroidism is the replacement with synthetic L-thyroxine (L-T4) sodium preparations. The target of the treatment is to maintain TSH levels between normal reference values. Detection of the underlying reason can be difficult in patients with higher L-T4 dose requirement than expected. In these patients, primarily non-adherence to the therapy should be remembered and then, whether there is an underlying reason or not should be investigated. 

  • 1. Jonklaas J, Bianco AC, Bauer AJ et al. Guidelines for the treatment of hypothyroidism. Thyroid 2014;24(12):1670-751.
  • 2. Türkiye Endokrinoloji ve Metabolizma Derneği, Tiroid Hastalıkları Tanı ve Tedavi Kılavuzu, Ankara: Ortadoğu Reklam Tanıtım Yayıncılık; 2017.
  • 3. Read DG, Hays MT, Hershman JM. Absorption of oral thyroxine in hypothyroid and normal man. J Clin Endocrinol Metab 1970;30:798-9.
  • 4. Centanni M, Benvenga S, Sachmechi I. Diagnosis and management of treatment refractory hypothyroidism: an expert consensus report. J Endocrinol Invest 2017;40:1289-301.
  • 5. Vaisman F, Coeli CM, Ward LS et al. How good is the levothyroxine replacement in primary hypothyroidism patients in Brasil? Data of a multicentre study. J Endocrinol Invest 2013;36:485-8. 6. Morris LS, Schulz RM. Medication compliance: the patient’s perspective. Clin Therapeutics 1993;15:593-606.
  • 7. Lips DJ, van Reisen MT, Voigt V, Venekamp W. Diagnosis and treatment of levothyroxine pseudomalabsorption. Netherlands J Med 2004;62:114-8.
  • 8. Grebe SK, Cooke RR, Ford HC et al. Treatment of hypothyroidism with once weekly thyroxine. J Clin Endocrinol Metab 1997;82(3):870-5.
  • 9. Garber JR, Cobin RH, Gharib H et al. Clinical Practice Guidelines for hypothyroidism in Adults: Cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association. Thyroid 2012;22:1200-35.
  • 10. Mc Dermott JH, Coss A, Walsh JH. Case History: Celiac disease presenting as resistant hypothyroidism. Thyroid 2005;15(4):386-8.
  • 11. Virili C, Bassotti G, Santaguida MG et al. Atypical celiac disease as cause of increased need for thyroxine: A systematic study. J Clin Endocrinol Metab 2012;97(3):419-22.
  • 12. Zubarik R, Ganguly E, Nathan M, Vecchio J. Celiac disease detection in hypothyroid patients requiring elevated thyroid supplementation: A prospective cohort study. Eur J Intern Med 2015; 26(10): 825-9.
  • 13. Cellini M, Santaguida MG, Gatto I et al. Systemic appraisal of lactose intolerance as cause of increased need for oral thyroxine. J Clin Endocrinol Metab 2014;99(8):1454-8.
  • 14. Asik M, Gunes F, Binnetoglu E et al. Decrease in TSH levels after lactose restriction in Hashimoto’s thyroiditis patients with lactose intolerance. Endocrine 2014;46:279-84.
  • 15. Centanni M, Gargano L, Canettieri G et al. Thyroxine in goiter, Helicobacter pylori infection, and chronic gastritis. N Engl J Med 2006;354:1787-95.
  • 16. Benvenga S, Papi G, Antonelli A. Refractory hypothyroidism due to improper storage of levothyroxine tablets. Front Endocrinol 2017;8:155.
  • 17. U.S. Food and Drug Administration 2008 Tirosint (Levothyroxine Sodium) Capsules. Available at: www.accessdata.fda.gov/drugsatfda_docs/nda/2006/021924s000TOC.cfm, Access date: August 19, 2012.
  • 18. Vita R, Saraceno S, Trimarchi F, Benvenga S. Switching Levothyroxine from the tablet to the oral solution formulation corrects the impaired absorption of levothyroxine induced by proton-pump inhibitors. J Clin Endocrinol Metab 2014;99(12):4481-6.
  • 19. Benvenga S, Di Bari F, Vita R. Undertreated hypothyroidism due to calcium or iron supplementation corrected by oral liquid levothyroxine. Endocrine 2017;56:138-45.
  • 20. Virili C, Giovanella L, Fallahi P, Antonelli A, Santaguida MG, Centanni M, et al. Levothyroxine therapy: Changes of TSH levels by switching patients from tablet to liquid formulation. A systematic review and meta-analysis. Front Endocrinol 2017;9:10.
  • 21. Brancato D, Scorsone A, Saura G, Ferrara L, Di Noto A, Aiello V, et al. Comparison of TSH levels with liquid formulation versus tablet formulations of levothyroxine in the treatment of adult hypothyroidism. Endocr Pract 2014;20(7):657-62.
  • 22. Fallahi P, Ferrari SM, Antonelli A. In patients with subclinical hypothyroidism while in therapy with tablet L-T4, the liquid L-T4 formulation is more effective in restoring euthyroidism. Endocr Pract 2017;23:170-4.
  • 23. Fallahi P, Ferrari SM, Camastra S et al. TSH normalization in bariatric surgery patients after the switch from L-thyroxine in tablet to an oral liquid formulation. Obes Surg 2017;27(1):78-82.
  • 24. Vita R, Di Bari F, Benvenga S. Oral liquid levothyroxine solves the problem of tablet levothyroxine malabsorption due to concomitant intake of multiple drugs. Expert Opin Drug Deliv 2017;14(4):467-72.
Birincil Dil tr
Konular Sağlık Bilimleri
Dergi Bölümü Derlemeler
Yazarlar

Yazar: Oya Topaloğlu (Sorumlu Yazar)

Yazar: Bekir Çakır
Ülke: Turkey


Bibtex @derleme { amj435289, journal = {Ankara Medical Journal}, issn = {}, eissn = {2148-4570}, address = {Ankara Yıldırım Beyazıt Üniversitesi}, year = {2018}, volume = {18}, pages = {235 - 241}, doi = {10.17098/amj.435289}, title = {Tedaviye Dirençli Hipotiroidi}, key = {cite}, author = {Topaloğlu, Oya and Çakır, Bekir} }
APA Topaloğlu, O , Çakır, B . (2018). Tedaviye Dirençli Hipotiroidi. Ankara Medical Journal, 18 (2), 235-241. DOI: 10.17098/amj.435289
MLA Topaloğlu, O , Çakır, B . "Tedaviye Dirençli Hipotiroidi". Ankara Medical Journal 18 (2018): 235-241 <http://www.ankaramedicaljournal.com/issue/37842/435289>
Chicago Topaloğlu, O , Çakır, B . "Tedaviye Dirençli Hipotiroidi". Ankara Medical Journal 18 (2018): 235-241
RIS TY - JOUR T1 - Tedaviye Dirençli Hipotiroidi AU - Oya Topaloğlu , Bekir Çakır Y1 - 2018 PY - 2018 N1 - doi: 10.17098/amj.435289 DO - 10.17098/amj.435289 T2 - Ankara Medical Journal JF - Journal JO - JOR SP - 235 EP - 241 VL - 18 IS - 2 SN - -2148-4570 M3 - doi: 10.17098/amj.435289 UR - http://dx.doi.org/10.17098/amj.435289 Y2 - 2018 ER -
EndNote %0 Ankara Medical Journal Tedaviye Dirençli Hipotiroidi %A Oya Topaloğlu , Bekir Çakır %T Tedaviye Dirençli Hipotiroidi %D 2018 %J Ankara Medical Journal %P -2148-4570 %V 18 %N 2 %R doi: 10.17098/amj.435289 %U 10.17098/amj.435289