Nakano Yujiro, Hashimoto Koshi, Ohkiba Noriaki, Okuma Hideyuki, Minami Isao, Takahashi Hiromitsu, Tanaka Yuji, Yoshimoto Takanobu, Yamada Tetsuya
Department of Molecular Endocrinology and Metabolism, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, 113-8510, Japan.
Department of Preemptive and Metabolism, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, 113-8510, Japan.
Case Rep Endocrinol. 2019 Feb 5;2019:5986014. doi: 10.1155/2019/5986014. eCollection 2019.
Refractory hypothyroidism is caused by decreased gut absorption, increased metabolism, and poor compliance. Previous studies suggested that the weekly oral, suppository, or intramuscular administration of levothyroxine (LT4) is an effective treatment for refractory hypothyroidism. However, limited information is currently available on treatment involving the weekly intravenous administration of LT4. We managed a case of refractory hypothyroidism due to poor compliance, for which, by weekly intravenous LT4 administration, LT4 was intravenously administered weekly at a dose of 300 g without any adverse effects such as acute ischemic heart diseases or liver dysfunction and effectively maintained the euthyroid status for 14 months. The weekly oral administration of LT4 (700 g) was also safely performed and was as effective as its intravenous administration. We herein present precise clinical course of the present case including pharmacokinetic data during the weekly intravenous and oral administration of LT4 and discuss the safety and efficacy of the treatments.
难治性甲状腺功能减退症是由肠道吸收减少、代谢增加和依从性差引起的。先前的研究表明，每周口服、直肠给药或肌肉注射左甲状腺素（LT4）是治疗难治性甲状腺功能减退症的有效方法。然而，目前关于每周静脉注射LT4治疗的信息有限。我们处理了一例因依从性差导致的难治性甲状腺功能减退症病例，通过每周静脉注射LT4，以300μg的剂量每周静脉注射LT4，未出现急性缺血性心脏病或肝功能障碍等不良反应，并有效维持甲状腺功能正常状态达14个月。每周口服LT4（700μg）也安全进行，且与静脉注射效果相同。我们在此呈现本病例的精确临床过程，包括每周静脉注射和口服LT4期间的药代动力学数据，并讨论治疗的安全性和有效性。
