Tratamiento con dosis fija de tiroxina en gestantes con hipotiroidismo subclínico / Treatment with fixed thyroxine doses in pregnant women with subclinical hypothyroidism

Introducción El tratamiento del hipotiroidismo se hace habitualmente calculando la dosis de tiroxina en función del peso del paciente. En algunas situaciones se ha comprobado la utilidad de administrar dosis fijas de la hormona para normalizar la concentración de TSH, cuyo control es especialmente importante en el caso de pacientes gestantes. Pacientes y métodos Se administró una dosis fija de 50 mcg/día de tiroxina a 68 mujeres con hipotiroidismo subclínico diagnosticado durante la gestación, autoinmune o no, y se evaluó trimestralmente a través de la concentración de TSH la necesidad de modificarla. Se programaron incrementos o decrementos de 25 mcg/día en los casos en los que el cambio de dosis fuese necesario. Resultados El 42% de las pacientes alcanzaron una concentración plasmática de TSH inferior a 3μU/mL con la dosis de 50 mcg/día de tiroxina. Si se toman como referencia los valores de la población general no gestante, dicha dosis fue óptima durante el embarazo en el 79,4% de las pacientes; y no lo fue en el 20,6% restante. Discusión Nuestros datos sugieren que una dosis fija de 50 mcg/día de tiroxina es insuficiente en un porcentaje elevado de pacientes con hipotiroidismo diagnosticado en la gestación, tanto si se toman como valores de referencia de concentración de TSH los de la población general como (especialmente) si se usan las recomendaciones más recientes. Dosis de 75 mcg/día serán probablemente más adecuadas, aunque se necesitan estudios que evalúen la posibilidad de sobretratamiento con dichas dosis (AU)

Background Hypothyroidism is usually treated with thyroxine doses on patient weight. In some cases, however, fixed doses have proved to useful to normalize TSH levels, which is especially important during pregnancy. Patients and methods Sixty-eight women diagnosed with subclinical hypothyroidism, autoimmune or not, during pregnancy were given a fixed dose of thyroxine 50mcg/day. TSH measurements were performed to assess the need to change the dose, which was increased or decreased by 25mcg/day when necessary. Results With a dose of 50mcg/day of thyroxine, 42% of patients reached a TSH level less than 3μU/mL, 79.4% reached a TSH level less than 4.5μU/mL, and 20.6% had TSH levels higher than 4.5μU/mL.Discussion Our data suggest that a fixed dose of thyroxine 50mcg/day is inadequate in a significant proportion of pregnancy-diagnosed hypothyroidism regardless of whether the reference of TSH level used is 4.5 or 3μU/mL. Starting dose of 75mcg/day is probably more adequate, but studies are needed to evaluate the possibility of overtreatment with such dose (AU)

Treatment with fixed thyroxine doses in pregnant women with subclinical hypothyroidism.

BACKGROUND: Hypothyroidism is usually treated with thyroxine doses on patient weight. In some cases, however, fixed doses have proved to useful to normalize TSH levels, which is especially important during pregnancy. PATIENTS AND METHODS: Sixty-eight women diagnosed with subclinical hypothyroidism, autoimmune or not, during pregnancy were given a fixed dose of thyroxine 50 mcg/day. TSH measurements were performed to assess the need to change the dose, which was increased or decreased by 25 mcg/day when necessary. RESULTS: With a dose of 50 mcg/day of thyroxine, 42% of patients reached a TSH level less than 3 µU/mL, 79.4% reached a TSH level less than 4.5 µU/mL, and 20.6% had TSH levels higher than 4.5 µU/mL. DISCUSSION: Our data suggest that a fixed dose of thyroxine 50 mcg/day is inadequate in a significant proportion of pregnancy-diagnosed hypothyroidism regardless of whether the reference of TSH level used is 4.5 or 3 µU/mL. S starting dose of 75 mcg/day is probably more adequate, but studies are needed to evaluate the possibility of overtreatment with such dose.

[Behçet disease with isolated ACTH deficiency]. / Enfermedad de Behçet asociada a déficit de corticotropina.

We report a case of a patient with longstanding Behçet disease, with neurological symptoms predominantly, who became hospitalized for adrenal insufficiency, caused by isolated deficiency of corticotropin (DAACTH). DAACTH is a typical characteristic of hypophysitis, reported in association with many autoimmune diseases. Nevertheless, hypothalamic-pituitary injury in Behçet disease is exceptional. We review the literature and possible mechanisms of this association until now not reported.