三碘甲状腺原氨酸联合左旋甲状腺素治疗甲状腺功能减退症的安全性综述。

IF 2.4 4区 医学 Q1 MEDICINE, GENERAL & INTERNAL Current Medical Research and Opinion Pub Date : 2024-12-01 Epub Date: 2024-12-03 DOI:10.1080/03007995.2024.2435460
Ulrike Gottwald-Hostalek, Yorki Tayrouz
{"title":"三碘甲状腺原氨酸联合左旋甲状腺素治疗甲状腺功能减退症的安全性综述。","authors":"Ulrike Gottwald-Hostalek, Yorki Tayrouz","doi":"10.1080/03007995.2024.2435460","DOIUrl":null,"url":null,"abstract":"<p><p>There remains considerable interest in the therapeutic use of combinations of levothyroxine (LT4) and triiodothyronine (liothyronine, T3) in the management of hypothyroidism, especially where hypothyroid-like symptoms persist on optimised LT4 monotherapy. This interest appears to be increasing, despite the lack of consistent identification of clinical benefit in people with hypothyroidism in randomised trials going back two decades. Guidelines support an individualised trial of addition of T3 to LT4 for symptomatic patients on optimised LT4. A new generation of clinical trials seeks to address this issue, using thyroid-specific instruments to measure patient-reported outcomes, among other innovations. Safety is the other critical element of the therapeutic profile of a drug. In this article, we review the safety of treatment LT4 + T3, with an emphasis on side-effects suggestive of thyrotoxicosis (overtreatment with thyroid hormones). Randomised trials that evaluated LT4 + T3 did not raise clear or consistent safety issues with this treatment. This was despite the use of regimens with a lower ratio of LT4:T3 (usually 4-10:1) than recommended currently by clinical experts in the field. In addition, a real-world analysis of side-effects of a commercial LT4 + T3 treatment (LT4:T3 ratio 5:1) that were reported spontaneously to a pharmacovigilance database revealed a low rate of reports, both overall and with regard to symptoms possible reminiscent of thyrotoxicosis. Safety concerns regarding the possibility of iatrogenic thyrotoxicosis appear unlikely to limit the future guideline-driven therapeutic use of LT4:T3 combinations with a ratio of these ingredients of around 15:1.</p>","PeriodicalId":10814,"journal":{"name":"Current Medical Research and Opinion","volume":" ","pages":"2109-2116"},"PeriodicalIF":2.4000,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"A review of the safety of triiodothyronine in combination with levothyroxine for the management of hypothyroidism.\",\"authors\":\"Ulrike Gottwald-Hostalek, Yorki Tayrouz\",\"doi\":\"10.1080/03007995.2024.2435460\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><p>There remains considerable interest in the therapeutic use of combinations of levothyroxine (LT4) and triiodothyronine (liothyronine, T3) in the management of hypothyroidism, especially where hypothyroid-like symptoms persist on optimised LT4 monotherapy. This interest appears to be increasing, despite the lack of consistent identification of clinical benefit in people with hypothyroidism in randomised trials going back two decades. Guidelines support an individualised trial of addition of T3 to LT4 for symptomatic patients on optimised LT4. A new generation of clinical trials seeks to address this issue, using thyroid-specific instruments to measure patient-reported outcomes, among other innovations. Safety is the other critical element of the therapeutic profile of a drug. In this article, we review the safety of treatment LT4 + T3, with an emphasis on side-effects suggestive of thyrotoxicosis (overtreatment with thyroid hormones). Randomised trials that evaluated LT4 + T3 did not raise clear or consistent safety issues with this treatment. This was despite the use of regimens with a lower ratio of LT4:T3 (usually 4-10:1) than recommended currently by clinical experts in the field. In addition, a real-world analysis of side-effects of a commercial LT4 + T3 treatment (LT4:T3 ratio 5:1) that were reported spontaneously to a pharmacovigilance database revealed a low rate of reports, both overall and with regard to symptoms possible reminiscent of thyrotoxicosis. Safety concerns regarding the possibility of iatrogenic thyrotoxicosis appear unlikely to limit the future guideline-driven therapeutic use of LT4:T3 combinations with a ratio of these ingredients of around 15:1.</p>\",\"PeriodicalId\":10814,\"journal\":{\"name\":\"Current Medical Research and Opinion\",\"volume\":\" \",\"pages\":\"2109-2116\"},\"PeriodicalIF\":2.4000,\"publicationDate\":\"2024-12-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Current Medical Research and Opinion\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1080/03007995.2024.2435460\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/12/3 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q1\",\"JCRName\":\"MEDICINE, GENERAL & INTERNAL\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Current Medical Research and Opinion","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1080/03007995.2024.2435460","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/12/3 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"MEDICINE, GENERAL & INTERNAL","Score":null,"Total":0}
引用次数: 0

摘要

左旋甲状腺素(LT4)和三碘甲状腺原氨酸(liothyronine, T3)联合用于治疗甲状腺功能减退,特别是在优化的LT4单药治疗中甲状腺功能减退样症状持续存在的情况下,仍有相当大的兴趣。尽管在20年前的随机试验中缺乏对甲状腺功能减退患者临床益处的一致确认,但这种兴趣似乎正在增加。指南支持个体化试验,对使用优化LT4的有症状患者在LT4基础上添加T3。新一代的临床试验试图解决这个问题,使用甲状腺特异性仪器来测量患者报告的结果,以及其他创新。安全性是药物治疗效果的另一个关键因素。在本文中,我们回顾了LT4 + T3治疗的安全性,并强调了提示甲状腺毒症(甲状腺激素过度治疗)的副作用。评估LT4 + T3的随机试验没有提出明确或一致的安全性问题。尽管使用的方案LT4:T3比率(通常为4-10:1)低于该领域临床专家目前推荐的比例,但仍存在这种情况。此外,对一种商业LT4 + T3治疗(LT4:T3比5:1)的副作用的实际分析显示,在药物警戒数据库中自发报告的报告率很低,无论是总体上还是在症状方面都可能使人联想到甲状腺毒症。关于医源性甲状腺毒症可能性的安全性担忧似乎不太可能限制未来指南驱动的LT4:T3组合治疗使用,这些成分的比例约为15:1。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
查看原文
分享 分享
微信好友 朋友圈 QQ好友 复制链接
本刊更多论文
A review of the safety of triiodothyronine in combination with levothyroxine for the management of hypothyroidism.

There remains considerable interest in the therapeutic use of combinations of levothyroxine (LT4) and triiodothyronine (liothyronine, T3) in the management of hypothyroidism, especially where hypothyroid-like symptoms persist on optimised LT4 monotherapy. This interest appears to be increasing, despite the lack of consistent identification of clinical benefit in people with hypothyroidism in randomised trials going back two decades. Guidelines support an individualised trial of addition of T3 to LT4 for symptomatic patients on optimised LT4. A new generation of clinical trials seeks to address this issue, using thyroid-specific instruments to measure patient-reported outcomes, among other innovations. Safety is the other critical element of the therapeutic profile of a drug. In this article, we review the safety of treatment LT4 + T3, with an emphasis on side-effects suggestive of thyrotoxicosis (overtreatment with thyroid hormones). Randomised trials that evaluated LT4 + T3 did not raise clear or consistent safety issues with this treatment. This was despite the use of regimens with a lower ratio of LT4:T3 (usually 4-10:1) than recommended currently by clinical experts in the field. In addition, a real-world analysis of side-effects of a commercial LT4 + T3 treatment (LT4:T3 ratio 5:1) that were reported spontaneously to a pharmacovigilance database revealed a low rate of reports, both overall and with regard to symptoms possible reminiscent of thyrotoxicosis. Safety concerns regarding the possibility of iatrogenic thyrotoxicosis appear unlikely to limit the future guideline-driven therapeutic use of LT4:T3 combinations with a ratio of these ingredients of around 15:1.

求助全文
通过发布文献求助,成功后即可免费获取论文全文。 去求助
来源期刊
Current Medical Research and Opinion
Current Medical Research and Opinion 医学-医学:内科
CiteScore
4.40
自引率
4.30%
发文量
247
审稿时长
3-8 weeks
期刊介绍: Current Medical Research and Opinion is a MEDLINE-indexed, peer-reviewed, international journal for the rapid publication of original research on new and existing drugs and therapies, Phase II-IV studies, and post-marketing investigations. Equivalence, safety and efficacy/effectiveness studies are especially encouraged. Preclinical, Phase I, pharmacoeconomic, outcomes and quality of life studies may also be considered if there is clear clinical relevance
期刊最新文献
A review of clinical applications of pharmacokinetic simulations for a 2-month long-acting injectable formulation of aripiprazole. Perioperative and periprocedural management of GLP-1 receptor-based agonists and SGLT2 inhibitors: narrative review and the STOP-GAP and STOP DKA-2 algorithms. Communicating scientific evidence: drugs for Alzheimer's disease as a case study. The response to pericapsular soft tissue and pelvic realignment therapy may be partially predicted by the relevant factors influencing the program's response of the candidates with hip osteoarthritis for joint replacement. Assessment of clinical characteristics and mortality in patients hospitalized with SARS-CoV-2 from January 2022 to November 2022, when Omicron variants were predominant in the United States.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
已复制链接
已复制链接
快去分享给好友吧!
我知道了
×
扫码分享
扫码分享
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1