早餐时口服左甲状腺素钠溶液治疗：一个错误？
Oral liquid levothyroxine treatment at breakfast: a mistake?
机构信息
Endocrine and Metabolic Unit, Clinica Medica, Department of Clinical and Experimental Sciences, University of Brescia, c/o 1^ Medicina Spedali Civili di Brescia, Piazzale Spedali Civili no. 1, 25100 Brescia, Italy.
出版信息
Eur J Endocrinol. 2013 Nov 22;170(1):95-9. doi: 10.1530/EJE-13-0693. Print 2014 Jan.
OBJECTIVE
Taking levothyroxine (L-T₄) with coffee or with water followed by coffee intake within a few minutes results in poor TSH response in many patients. T₄ is available in tablet form worldwide, but novel formulations in soft gel capsule or liquid form are now available.
DESIGN
We fortuitously identified a euthyroid patient who wrongly consumed liquid L-T₄ with coffee at breakfast; after changing the time of consumption to 30 min before breakfast, no change in TSH, free T₄ (fT₄), and free tri-iodothyronine (fT₃) concentrations was observed. Once the first patient was identified, additional stable euthyroid patients who consumed liquid L-T₄ with coffee were identified.
METHODS
Patients were recruited by searching our 'thyroid patients' database. All the patients on liquid L-T₄ treatment were contacted by phone to ask them whether they took L-T₄ at breakfast. We identified 54 patients who were submitted to TSH, fT₄, and fT₃ evaluation, with the indication that the same dosage of L-T₄ be consumed 30 min before breakfast. We determined their TSH, fT₄, and fT₃ concentrations after 3 and 6 months again.
RESULTS
no significant difference in thyroid hormone concentrations was observed in patients when they consumed L-T₄ at breakfast or when they consumed it 30 min before breakfast for 3 and 6 months (TSH: 2.5±1.1 vs 2.5±1.1 and 2.4±1.1 mIU/l respectively, fT₄: 12.4±2.4 vs 12.5±2.4 and 12.3±2.1 pg/ml respectively, and fT₃: 3.4±0.6 vs 3.4±0.6 and 3.3±0.5 pg/ml respectively).
CONCLUSION
Oral liquid L-T₄ formulations could diminish the problem of L-T₄ malabsorption caused by coffee when using traditional tablet formulations.
目的
许多患者在服用左甲状腺素（L-T₄）后几分钟内喝咖啡或饮用咖啡后再摄入 L-T₄，导致 TSH 反应不佳。L-T₄ 已在全球范围内以片剂形式供应，但现在有新型软凝胶胶囊或液体形式的制剂。
设计
我们偶然发现了一位甲状腺功能正常的患者，他在早餐时错误地服用了含咖啡的液体 L-T₄；将服用时间改为早餐前 30 分钟后，未观察到 TSH、游离 T₄（fT₄）和游离三碘甲状腺原氨酸（fT₃）浓度的变化。一旦确定了第一个患者，我们就通过搜索“甲状腺患者”数据库找到了另外一些服用含咖啡的液体 L-T₄的稳定甲状腺功能正常的患者。
方法
通过搜索“甲状腺患者”数据库招募患者。通过电话联系所有服用液体 L-T₄ 的患者，询问他们是否在早餐时服用 L-T₄。我们确定了 54 名患者进行 TSH、fT₄ 和 fT₃ 评估，并指示他们在早餐前 30 分钟服用相同剂量的 L-T₄。我们再次在 3 个月和 6 个月后测定他们的 TSH、fT₄ 和 fT₃ 浓度。
结果
在早餐时或在早餐前 30 分钟服用 L-T₄ 3 个月和 6 个月后，患者的甲状腺激素浓度无显著差异（TSH：2.5±1.1 与 2.5±1.1 和 2.4±1.1 mIU/l 分别，fT₄：12.4±2.4 与 12.5±2.4 和 12.3±2.1 pg/ml 分别，fT₃：3.4±0.6 与 3.4±0.6 和 3.3±0.5 pg/ml 分别）。
结论
与传统片剂制剂相比，口服液体 L-T₄ 制剂可以减少因使用咖啡而导致的 L-T₄ 吸收不良问题。
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