甲状腺功能亢进症的药物治疗

Pharmaceutical treatment for hyperthyroidism

摘要:

甲状腺功能亢进症（甲亢）病因较复杂，在临床上以弥漫性毒性甲状腺肿伴甲亢（Graves病）最常见。甲亢的药物治疗包括抗甲状腺药（ATD）、碘剂、β受体阻滞剂、糖皮质激素、碳酸锂等。ATD是治疗甲亢的主要手段，常用药物为丙基硫氧嘧啶（PTU）和甲巯咪唑（MMI）。总的来说，ATD治疗安全且有效，但其临床不良反应亦较常见，一般程度较轻，及时停药能自行恢复，但亦可出现少见、严重的副作用。MMI与PTU比较，其不良反应显著低于PTU，且前者大多具有剂量依赖性。因此轻中度甲亢及甲亢维持治疗首选MMI。复方碘溶液用于术前准备及甲亢危象等；糖皮质激素主要用于甲状腺相关性眼病、甲亢危象等；β受体阻滞剂多用于控制甲亢初治期的症状；碳酸锂一般不作为常规使用，仅适合短期治疗。临床医师根据患者的病情及个体差异综合考虑，选用合适的治疗方案，密切监测疗效及不良反应。

Abstract:

The pathogenesis of hyperthyroidism is relatively complicated. In clinical practice, diffuse toxic goiter accompanied with hyperthyroidism (as known as Graves￠ disease) is more common. The pharmaceutical treatment of Graves￠ disease includes antithyroid drugs (ATD), iodine, β-blocker, glucocorticoids and lithium carbonate. ATD are the main treatment for hyperthyroidism, and Methimazole (MMI) and propylthiouracil (PTU) are the two drugs which are most commonly used currently. Generally, ATD are safe and effective, though their clinical adverse reactions are also relatively common. These reactions are usually reversible and disappeared spontaneously when the drug is discontinued. However, the serious rare side effects also occur sometimes. MMI is usually preferred over PTU because it has significantly fewer adverse reactions in a dose-dependent fashion. MMI is the first choice for treating mild and moderate hyperthyroidism. Iodine is mainly used in hyperthyroidism crisis and before operation. Glucocorticoids are mainly used for Graves￠ ophthalmopathy and hyperthyroidism crisis. β-blocker is used to control the symptoms at initial treatment. Lithium carbonate is not commonly used, and only suitable for short-term treatment. The clinicians should evaluate comprehensively and individually to choose appropriate agents for better outcome, and closely monitor their efficiency and side effects.