Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.
Master Program on Childhood, Adolescent and Women's Endocrine Health, University of Messina, Messina, Italy.
Front Endocrinol (Lausanne). 2020 Dec 22;11:607446. doi: 10.3389/fendo.2020.607446. eCollection 2020.
Pharmacological interference on L-thyroxine (L-T4) therapy can be exerted at several levels, namely from the hypothalamus/pituitary through the intestine, where the absorption of exogenous L-T4 takes place. A number of medications interfere with L-T4 therapy, some of them also being the cause of hypothyroidism. The clinician should be aware that some medications simply affect thyroid function tests with no need of modifying the dose of L-T4 that the patient was taking prior to their prescription. Usually, the topic of pharmacological interference on L-T4 therapy addresses the patient with primary hypothyroidism, in whom periodic measurement of serum thyrotropin (TSH) is the biochemical target. However, this minireview also addresses the patient with central hypothyroidism, in whom the biochemical target is serum free thyroxine (FT4). This minireview also addresses two additional topics. One is the costs associated with frequent monitoring of the biochemical target when L-T4 is taken simultaneously with the interfering drug. The second topic is the issue of metabolic/cardiovascular complications associated with undertreated hypothyroidism.
药物对左甲状腺素（L-T4）治疗的干扰可以在多个层面上发生，即从下丘脑/垂体到肠道，外源性 L-T4 的吸收就在这里进行。许多药物会干扰 L-T4 的治疗，其中一些还会导致甲状腺功能减退。临床医生应该意识到，有些药物只是影响甲状腺功能检查，而无需改变患者在开处方前服用的 L-T4 剂量。通常，药物对 L-T4 治疗的干扰这个话题涉及到原发性甲状腺功能减退症患者，在这些患者中，定期测量血清促甲状腺激素（TSH）是生化指标。然而，这篇小综述也涉及到中枢性甲状腺功能减退症患者，在这些患者中，生化指标是血清游离甲状腺素（FT4）。这篇小综述还涉及另外两个话题。一个是当 L-T4 与干扰药物同时服用时，频繁监测生化指标所涉及的成本。第二个话题是与治疗不足的甲状腺功能减退症相关的代谢/心血管并发症的问题。
