Fármacos de amplo uso na prática clínica que interagem com os hormônios tireoidianos / Widely used drugs in clinical practice that interact with thyroid hormones

Vários fármacos de amplo uso na prática clínica interagem com os hormônios tireoidianos, alterando a função da tireoide. Boa parte dos pacientes submetidos à avaliação da tireoide faz uso de diversos fármacos, sendo importante saber quais são as interações. O objetivo deste estudo foi rever, na literatura, os principais medicamentos amplamente utilizados na prática clínica que interagem com os hormônios tireoidianos. A produção desses hormônios ocorre por meio de diversos mecanismos, que podem interagir com várias drogas, resultando em disfunção tireoidiana. Alguns fármacos podem causar tanto tireotoxicose, como hipotireoidismo; é o caso do iodo, da amiodarona e da interleucina-2. A radiação ionizante pode produzir tireoidite aguda, crônica e câncer de tireoide. O carbonato de lítio inibe a secreção dos hormônios tireoidianos, estimulando o hormôniotireo estimulante e levando à formação de bócio. A quimioterapia citotóxica pode causar alterações no hipotálamo, na hipófise e na tireoide. Os glicocorticoides apresentam efeitos variáveis e múltiplos. Alguns fármacos afetam as proteínas transportadoras de hormônios tireoidianos, como os salicilatos, a heparina e o estrogênio. Anticonvulsivantes atuam sobre os hormônios tireoidianos, interferindo na ligação com proteínas transportadoras e acelerando o metabolismo hepático. A dopamina inibe diretamente a secreção do TSH. O propranolol tem efeito discreto, relacionado a doses >160mg/dia.O conhecimento sobre as interações permite identificar uma droga como causa de disfunção da tireóide, a execução de testes de triagem em indivíduos expostos a elas e evitar seu uso em pacientes com risco de desenvolver doenças da tireóide...

Many drugs of wide use in clinical practice interact with thyroid hormones, changing thyroid function. Much of the patients that have their thyroid studied make use of multiple medications, being important to know which the interactionsare. The aim of this study was to review in the literature the main drugs widely used in clinical practice that interacts with thyroid hormones. The production of these hormones occurs through several mechanisms which may interact with various drugs, causing thyroid dysfunction. Some medicines cancause both thyrotoxicosis and hypothyroidism, such as iodine, amiodarone and interleukin-2. Ionizing radiation may produce acute thyroiditis, chronic thyroiditis and thyroid cancer. Lithium carbonate inhibits the secretion of thyroid hormones, stimulating TSH, leading to the formation of goiter. Cytotoxic chemotherapy can cause changes in the hypothalamus, pituitary and thyroid. Glucocorticoids have multiple and variables effects. Some drugs affect thyroid hormones transporter proteins, such assalicylates, heparin and estrogen. Anticonvulsants have effect on thyroid hormones, interfering with protein binding carriers and accelerating hepatic metabolism. Dopamine inhibits directly the secretion of TSH. Propranolol has slight effect, related to doses>160mg/day. The knowledge about the interactions allows to identify a drug as a cause of thyroid dysfunction, the execution of screening tests in individuals exposed to them and avoid its use in patients with risk of developing thyroid disease...

The change of thyroid hormones and leptin at hyperuricemia/gout / 中国医师杂志

Objective To explore the change of thyroid hormones and leptin at hyperuricemia (HUA)/gout.Methods A total of 96 primary gouts,65 HUAs,and 59 healthy examiners was selected.Height,weight,blood pressure,renal function,serum uric acid(SUA),glucose,lipid profiles,insulin,thyroid hormones were measured after an overnight fast.Results (1) The prevalence of subhypothyriodism at gout and HUA was 7.29％ and 15.38％,respectively.They were higher than that at healthy subjects.(2) Body mass index (BMI),systolic blood pressure (SBP),triglyceride (TG),cholesterol (CHO),thyroid stimulating hormone (TSH),fasting insulin (FINS),homeostasis model assessment of insulin resistance (HOMA-IR),and serum leptin level were increased remarkably at gout/hyperuricemia relative to control group,whereas,free thyroid hormone (FT4) was decreased.(4) In the gout and hyperuricemia groups,TSH was used as the dependent variable for the linear multivariate regression analysis,the results showed that sex,age,BMI,SUA,FT4,HOMA-IR,and Leptin were included in the regression equation of TSH (βwere-0.27,0.832,0.946,0.198,-0.942,0.895,and 0.650,respectively).Conclusions The prevalence of subhypothyroidism in primary gout/hyperuricemia was increased.Female,age,BMI,SUA,FT4,HOMA-IR,and leptin were the independent risk factors.Insulin resistant and leptin played the media roles in the gout/HUA and hypothyroidism.

Comparison of Serum Levels of Thyroid Hormones and Thyroid-Stimulating Hormone in Excess-Heat and Deficiency-Heat Patients / 广州中医药大学学报

[Objective] To investigate the relationship of thyroid hormones with excess-heat syndrome and deficiency-heat syndrome. [Methods] Serum levels of thyroid hormones and thyroid-stimulating hormone (TSH) in 30 healthy volunteers (Group A) , 27 cases of excess-heat syndrome (Group B) and 35 cases of deficiency-heat syndrome (Group C) were detected by radioimmunoassay. [Results] Serum levels of triiodothyronine (T3) and thyroxine (T4) were higher and reverse T3 (rT3) lower in Group C than those in Group A (P 0.05). [Conclusion] Serum thyroid hormones level in deficiency-heat syndrome is different from that of excess-heat syndrome may be related to the hypothalamus-pituitary-thyroid function.

Effect of Danhong Injection on Thyroid Hormone Level in Patients with Angina Due to Coronary Heart Disease / 广州中医药大学学报

Objective To observe the effect of Danhong Injection(DI)on the thyroid hormone level in patients with angina due to coronary heart disease(CHD).Methods Sixty CHD angina patients were equally randomized into the treatment group and the control group.The two groups received routine western medicine such as aspirin,angiotensin convert enzyme inhibitor(ACEI),statins,beta-blockers and nitrate esters,and the treatment group was additionally given intravenous drip transfusion of DI 20 mL,qd.Twenty days constituted one treatment course.After treatment,the therapeutic effect was evaluated and the changes of serum thyroid hormone level were observed.Results In the control group,13 patients were markedly effective,9 effective,8 ineffective,and the total effective rate was 73.3%;in the treatment group,19 patients were markedly effective,6 effective,5 ineffective,and the total effective rate was 83.3%;the difference between the two groups was significant(P

Effect of Buzhong Yiqi Wan on Thyroid Hormones in Rat Model of Spleen-asthenia / 广州中医药大学学报

【Objective】To observe the effect of Buzhong Yiqi Wan(BYW)on thyroid hormones in rat model of spleen-asthenia.【Methods】Thirty-four SD male rats were randomized into 3 groups:normal control group(N=10),spleen-asthenia model group(N=12),BYW group(N=12).Except the normal control group,the rats in other groups were given the decoction of Radix et Rhizoma Rhei(4 g?d-1 for each rat)to induce spleen asthenia,and meanwhile,BYW group reveived BYW(3.9 g?kg-1?d-1).The treatment lasted 20 days.Radioimmunoassay was used to detect serum levels of triiodothyronine(T3),thyroxine(T4),reverse triiodothyronine(rT3)and thyroid stimulating hormone(TSH).Meanwhile,the body weight,spleen and thymus weight as well as their ratio with the body weight were also observed.【Results】Serum T3 and T4 levels,spleen and thymus weight as well as their ratio with the body weight were decreased in the model group as compared with those in the normal control group(P