Toro-Diez Andrea Del, Solá-Sánchez Ernesto, Mangual-García Michelle
Endocrinology Department, San Juan City Hospital, San Juan, Puerto Rico.
Endocrinol Diabetes Metab Case Rep. 2021 Jul 1;2021. doi: 10.1530/EDM-21-0045.
Primary hypothyroidism is one of the most common endocrine disorders with widely available treatment. A minority of patients remain with uncontrolled hypothyroidism despite therapy. The objective of this case series was to demonstrate that medication non-adherence, rather than malabsorption, should be sought as the most common cause of unsuppressed TSH levels in patients receiving treatment for this condition. Non-adherence is often considered as a diagnosis of exclusion. Nonetheless, a diagnosis of malabsorption requires a more extensive workup, including imaging and invasive procedures, which increase healthcare costs and burden to the patient. The findings of this study allow for a cost-effective approach to uncontrolled hypothyroidism.
Medication non-adherence is a common cause of insuppressible TSH levels. Once weekly levothyroxine is an alternative approach to non-compliant patients. Assessing compliance is more cost-effective and less burdensome than testing for malabsorption.
原发性甲状腺功能减退症是最常见的内分泌疾病之一，治疗方法广泛可得。尽管进行了治疗，但仍有少数患者的甲状腺功能减退症未得到控制。本病例系列的目的是证明，对于接受这种疾病治疗的患者，未受抑制的促甲状腺激素（TSH）水平最常见的原因应是药物治疗依从性差，而非吸收不良。治疗依从性差通常被视为一种排除性诊断。然而，吸收不良的诊断需要更广泛的检查，包括影像学检查和侵入性操作，这会增加医疗成本和患者负担。本研究结果为未得到控制的甲状腺功能减退症提供了一种经济有效的治疗方法。
药物治疗依从性差是促甲状腺激素水平无法被抑制的常见原因。对于不依从的患者，每周一次左甲状腺素是一种替代方法。评估依从性比检测吸收不良更具成本效益且负担更小。
