Rizzo Leonardo F L, Mana Daniela L, Serra Héctor A
Dirección Médica Química Montpellier SA, Argentina.
Dirección Médica Química Montpellier SA, Argentina. E-mail:
Medicina (B Aires). 2017;77(5):394-404.
The thyroid axis is particularly prone to interactions with a wide variety of drugs, whose list increases year by year. Hypothyroidism is the most frequent consequence of drug-induced thyroid dysfunction. The main mechanisms involved in the development of primary hypothyroidism are: inhibition of the synthesis and/or release of thyroid hormones, immune mechanisms related to the use of interferon and other cytokines, and the induction of thyroiditis associated with the use of tyrosine kinase inhibitors and drugs blocking the receptors for vascular endothelial growth factor. Central hypothyroidism may be induced by inhibition of thyroid-stimulating hormone (bexarotene or corticosteroids) or by immunological mechanisms (anti-CTLA4 or anti-PD-1 antibody drugs). It is also important to recognize those drugs that generate hypothyroidism by interaction in its treatment, either by reducing the absorption or by altering the transport and metabolism of levothyroxine. Thus, it is strongly recommended to evaluate thyroid function prior to the prescription of medications such as amiodarone, lithium, or interferon, and the new biological therapies that show important interaction with thyroid and endocrine function in general.
甲状腺轴特别容易与各种各样的药物发生相互作用，这类药物的清单逐年增加。甲状腺功能减退是药物性甲状腺功能障碍最常见的后果。原发性甲状腺功能减退发生的主要机制有：抑制甲状腺激素的合成和/或释放、与使用干扰素及其他细胞因子相关的免疫机制，以及与使用酪氨酸激酶抑制剂和阻断血管内皮生长因子受体的药物相关的甲状腺炎诱导。中枢性甲状腺功能减退可能由抑制促甲状腺激素（贝沙罗汀或皮质类固醇）或免疫机制（抗CTLA4或抗PD-1抗体药物）引起。认识到那些在治疗中通过相互作用导致甲状腺功能减退的药物也很重要，这些相互作用要么通过减少吸收，要么通过改变左甲状腺素的转运和代谢来实现。因此，强烈建议在开具胺碘酮、锂或干扰素等药物以及一般而言与甲状腺和内分泌功能有重要相互作用的新生物疗法之前评估甲状腺功能。
