Akin Fulya, Yaylali Guzin Fidan, Bastemir Mehmet, Yapar Burcu
Pamukkale University, School of Medicine, Department of Endocrinology and Metabolic Diseases, Denizli, Turkey.
Blood Coagul Fibrinolysis. 2008 Jan;19(1):89-91. doi: 10.1097/MBC.0b013e3282f0981f.
The article describes a case of Graves' disease treated with methimazole and examines the influence of methimazole-induced alterations of thyroid hormone concentrations during warfarin therapy. A 22-year-old woman presented at our endocrinology outpatient clinic with palpitations, sweating, fatigue, tremors, and diarrhea. She had a pain in her right leg and had difficulty walking. Her thyroid profile was consistent with hyperthyroidism. The patient was treated with warfarin 5 mg once a day for deep vein thrombosis for 2 days. Since a therapeutic range of International Normalized Ratio levels could not be achieved, methimazole was stopped due to drug-drug interaction. Lithium was started instead. A euthyroid state was obtained in 2 weeks together with a therapeutic International Normalized Ratio level. Interactions between warfarin and drugs that alter thyroid hormone concentrations have been reported; however, the extent and significance of the interaction between methimazole and warfarin have been inadequately described. Concomitant therapy with warfarin and antithyroid drugs should be managed by frequent monitoring of both thyroid function and the International Normalized Ratio. Lithium is employed only to provide temporary control of thyrotoxicosis in patients who cannot take thionamide and iodide. The administration of lithium alone or in combination with other drugs is shown to be an effective method of controlling hyperthyroidism when conventional antithyroid drugs show adverse effects or become insufficient. When warfarins are used together with antithyroid medications, adequate anticoagulation may not be obtained due to drug-drug interactions. Lithium can be an alternative drug for antithyroid medication in patients on warfarin therapy.
本文描述了一例用甲巯咪唑治疗的格雷夫斯病病例,并研究了在华法林治疗期间甲巯咪唑引起的甲状腺激素浓度变化的影响。一名22岁女性因心悸、出汗、疲劳、震颤和腹泻前来我们内分泌门诊就诊。她右腿疼痛,行走困难。她的甲状腺功能检查结果符合甲状腺功能亢进症。该患者因深静脉血栓形成接受华法林5毫克每日一次治疗2天。由于无法达到国际标准化比值水平的治疗范围,因药物相互作用停用了甲巯咪唑。改为开始使用锂盐。2周后甲状腺功能恢复正常,同时国际标准化比值水平达到治疗范围。已有报道称华法林与改变甲状腺激素浓度的药物之间存在相互作用;然而,甲巯咪唑与华法林之间相互作用的程度和意义尚未得到充分描述。华法林与抗甲状腺药物联合治疗时,应通过频繁监测甲状腺功能和国际标准化比值来进行管理。锂盐仅用于对不能服用硫代酰胺和碘化物的患者提供甲状腺毒症的临时控制。当传统抗甲状腺药物出现不良反应或效果不佳时,单独使用锂盐或与其他药物联合使用是控制甲状腺功能亢进症的有效方法。当华法林与抗甲状腺药物一起使用时,由于药物相互作用可能无法获得足够的抗凝效果。锂盐可以作为接受华法林治疗患者抗甲状腺药物的替代药物。