OPTIMIZATION OF LEVOTHYROXINE THERAPY BASED UPON COMPLEX EVALUATION OF HORMONAL AND IMMUNE STATUS IN THE PATIENTS WITH SUB-CLINICAL AND MANIFESTING HYPOTHYREOSIS
https://doi.org/10.15789/1563-0625-2006-5-6-697-706
Abstract
Abstract.The aim of present study was complex evaluation and analysis of hormone and immune profiles in the patients with subclinical and manifesting thyroid hypofunction, taking into account a therapeutic drug monitoring for optimization of levothyroxine treatment. Forty patients with thyroid hypofunction are included into the study: I group, patients with subclinical hypothyreosis (n=19) and the levels of thyroxine-binding globuline exceeding 700 nmol/l, who received levothyroxine at 50 μg daily after withdrawal of drugs for 10 days; II group, the patients with manifesting hypothyreosis (n=21), who received levothyroxine at 100 μg daily. A significant regress of clinical signs of hypothyreosis was registered in both groups following 3 months of receiving levothyroxine, employing an optimized mode of dosage. An immune/endocrine component is shown for the mechanism of levothyroxine action, which promotes the development of maximal hormonal effect, with respect to improvement of life quality in the patients with hypothyreosis upon optimization of therapy based on the therapeutic drug monitoring using liquid chromatography/mass-spectrometry.
About the Authors
I. V. SarvilinaRussian Federation
E. F. Shin
Russian Federation
Yu. V. Gorshkova
Russian Federation
References
1. Герасимов Г.А., Мельниченко Г.А., Фадеев В.В. Мифы отечественной тиреодологии и аутоиммунный тиреоидит // Consilium Medicum. – 2001. – Т.3. – №11. – С.37-46.
2. Кандор В.И. Современные проблемы тиреодологии // Пробл. эндокринол. – 1999. – №1. – С. 3-5.
3. Arem R., Escalante D. Subclinical hypothyroidism: epidemiology, diagnosis, and significance // Adv. Int. Med. – 1996. – Vol.41. – P.213-250.
4. Canaris G.J., Manowitz N.R., Mayor G., Ridgway E.C. The Colorado thyroid disease prevalence study // Arch Intern Med. – 2000. – Vol.160 - №4. – P.526-34.
5. Caturegli P., Mariotti S., Kuppers R.C., Burek C.L., Pinchera A., Rose N.R. Epitops on thyroglobulin: a study of patients with thyroid diseases// Autoimmunity. – 1994. – Vol.18. – Р.41-49.
6. Cooper D.S., Halpern R., Wood L.C., Levin A.A., Ridgway E.C. L-thyroxine therapy un subclinical hypothyroidism. A double-blind, placebo-controlled trial // Ann. Intern. Med. – 1984. – Vol.101. – Р.18-24.
7. Hak A.E., Pols H.A., Visser T.J., Drexhage H.A., Hofman A., Witteman J.C. Subclinical hypothyroidism is an independent risk factor for atherosclerosis and myocardial infarction in elderly women: the Rotterdam Study // Ann. Intern. Med. – 2000. – Vol. 132. – № 4. – P. 270-278.
8. Helfand M., Redfern C.C. Clinical guideline, part 2. Screening for thyroid disease: an update // Ann. Intern. Med. – 1998. – Vol. 129. – № 2. – Р.144-158.
9. Mariotti S., Caturegli P., Piccolo P., Barbesino G., Pinchera A. Antythyroid peroxidase antibodies thyroid diseases // J.Clin. Endocrinol. Metab. – 1990. – Vol.71. – P.661-669.
10. Mc Lachlan S.M., Rapoport B. The molecular biology of thyroid peroxidase: cloning, expression, and role as autoantigen in autoimmune thyroid disease // Endocrine Rev. – 1992. – Vol.13. – P.192-206.
11. Nystrom E., Bengtsson C., Lindquist O., Noppa H., Lindstedt G., Lundberg P.A. Thyroid disease and high concentration of serum thyrotropin in a population sample of women // Acta Med. Scand. – 1981. – Vol.210. – Р.39-46.
12. Permantier M., Libert F., Meanhaut C., Lefort A., Gerard C., Perret J., Van. Sande. J., Dumont J.E., Vassart G. Molecular cloning of the thyrotropin receptor // Science. – 1989. – Vol.246. – P.1620-1622.
13. Slatosky J., Shipton B., Wahba Haney. Thyroiditis: Differential Diagnosis and Management // American Family Physical. – 2000. – Vol.59. – P.615-621.
14. Tunbridge W.M., Evered D.C., Hall R., Appleton D., Brewis M., Clark F., Evans J.G., Young E., Bird T., Smith P.A. The spectrum of thyroid disease in a community: the Whickham survey // Clin. Endocrinol. –1977. – №7. – Р.481-490.
15. Vanderpump M.P.J., Tunbridge W.M.G., French J.M., Appleton D., Bates D., Clark F., Grimley Evans J., Hasan D.M., Rodgers H., Tunbridge F., Young E.T. The incidence of thyroid disoroles in the community: a twenty-year follow-up of the Whickham Survey // Clin. Endocrinol. – 1995. – Vol.43. – P.55-68.
16. Vassart G., Dumont J.E. The thyrotropin receptor and the regulation of thyroid function and grouth // Endocrine Rev. – 1992. – Vol.13. – P.596-611.
17. Woeber K.A. Subclinical thyroid dysfunction // Arch. Intern. Med. – 1997. – Vol. 157. – 1065-1068.
18. Zulewski H., Muller B., Exer P., Miserez A.R., Staub J.J. Estimation of tissue hypothyroidism by a new clinical score: evaluation of patients with various grades of hypothyroidism and controls // J. Clin. Endocrinol. Metab. – 1997. – Vol.82. – №3. – P. 771-776.
Review
For citations:
Sarvilina I.V., Shin E.F., Gorshkova Yu.V. OPTIMIZATION OF LEVOTHYROXINE THERAPY BASED UPON COMPLEX EVALUATION OF HORMONAL AND IMMUNE STATUS IN THE PATIENTS WITH SUB-CLINICAL AND MANIFESTING HYPOTHYREOSIS. Medical Immunology (Russia). 2006;8(5-6):697-706. (In Russ.) https://doi.org/10.15789/1563-0625-2006-5-6-697-706