갑상선 기능 저하 환자에서 levothyroxine 투여 시간에 따른 효능 비교: 메타분석

이기표,아영미,최혜덕 한국임상약학회 2020 한국임상약학회지 Vol.30 No.2

Background: Levothyroxine is an essential drug for the treatment of hypothyroidism or related diseases. Several studies have reported an association between the effects of levothyroxine treatment and time of administration, which can be inconsistent. Objective: This study was conducted to compare the levels of thyroid-stimulating hormone or free thyroxine between morning and nighttime dosing of levothyroxine. Methods: We reviewed previously reported relevant articles and conducted a meta-analysis. Results: In total, five studies were included in this meta-analysis. Results showed that thyroid-stimulating hormone (standard difference in means [SE]=0.321; 95% confidence interval [CI], -0.016 to 0.657) and free thyroxine (SE= −1.367; 95% CI, -2.943 to 0.210) levels did not differ significantly between morning (before breakfast) and nighttime (before bedtime) administration. Conclusion: This is the first meta-analysis to evaluate the effects of time of administration on levothyroxine levels in patients with hypothyroidism. Based on our results, we suggest considering patients’ lifestyles or daily routines when counselling them on the optimal time of administration for levothyroxine.

八味逍遙散加味方이 sodium levothyroxine으로 유발된 흰쥐의 갑상선중독증에 미치는 영향

이연성,소경순,정찬길 대한동의병리학회 2001 동의생리병리학회지 Vol.15 No.1

In order to study effect of 『Added prescription of Palmisoyo-San(八味逍遙散加味方)』 (AP) on the thyrotoxicosis rats induced by sodium levothyroxine, we have made thyrotoxicosis rats by administering sodium levothyroxine for 5days, then have administered solid extract of AP to thyrotoxicosis rats for 5 days. We measured the body weight(BW), body temperature(BT), levels of Serum T4 · T3 · TSH and urine 17-OHCS after administrating solid extract of AP. The results are summarized as follows : 1.The decreased BW was significantly increased by the administration of solid extract of AP(p<0.05). 2.The increased BT was significantly decreased by the administration of solid extract of AP(p<0.05). 3.In the serum T4 level, the group administered solid extract of AP showed significantly decreasing effect(p<0.05) 4.In the serum T3 level, the group administered solid extract of AP showed increasing tendency(p<0.05). 5.In the serum TSH level, the group administered solid extract of AP showed significantly decreasing effect(p<0.01). 6.In the urine 17-OHCS level, the group administered solid extract of AP showed significantly decreasing effect(p<0.01). 7.In the urine 17-OHCS level, the group administered sodium levothyroxine significantly increased(p<0.01). According to the above experimental result, 『Added prescription of Palmisoyo-San(八味逍遙散加味方)』 is assumed to have a curative effect against the thyrotoxicosis rat induced by sodium levothyroxine, which can be called 'Deficient Liver Yin(肝陰虛)' type thyrotoxicosis. Key word : Added prescription of Palmisoyo-San(八味逍遙散加味方), sodium levothyroxine, body weight & body temperature, T4, T3, TSH, urine 17-OHCS

갑상선 결절을 가진 폐경기 여성에서 단기간 갑상선 호르몬을 투여후 뇨중 Deoxypyridinoline의 변화

김수경,오형태,김상영,이승훈,서인석,김동윤 대한골대사학회 1995 대한골대사학회지 Vol.2 No.2

Combination therapy of liothyronine and levothyroxine for hypothyroidism-induced dilated cardiomyopathy

Choi Youngha,Jung Se Yong,Park Jung Min,Suh Junghwan,Shin Eun Jung,Chae Hyun Wook,Kim Ho-Seong,Kwon Ahreum 대한소아내분비학회 2023 Annals of Pediatirc Endocrinology & Metabolism Vol.28 No.2

Thyroid hormone plays a vital role in regulating human metabolism. They affect the functions of major organs, such as the brain, liver, skeletal muscle, and heart. Hypothyroidism can lead to dilated cardiomyopathy and decreased heart function. In this report, we describe a case of a teenage boy who developed dilated cardiomyopathy due to hypothyroidism and was considered to undergo heart transplantation. Levothyroxine monotherapy was initiated but produced no improvement. Thereafter, a combination therapy of liothyronine and levothyroxine was administered, and heart function was gradually restored; he recovered completely after 6 months. Cardiac myocytes respond more specifically to liothyronine than to levothyroxine. Therefore, we suggest that liothyronine and levothyroxine combination therapy should be considered rather than levothyroxine monotherapy for hypothyroidism accompanied by heart disease.

Levothyroxine으로 유발된 갑상선기능항진증 랫트에 대한 양격산화탕, 팔물군자탕 및 청폐사간탕의 효능 비교연구

김성태,최애련,Kim, Seong-Tae,Choi, Ae-Ryun 사상체질의학회 2016 사상체질의학회지 Vol.28 No.2

Objectives This study's object was to observe the comparative effects of Yangkyuksanhwa-tang, Palmulgunja-tang and Cheongpyesagan-tang on the chronic LT4(levothyroxine) induced hyperthyroidism in rats.Methods Six groups, each of 8 rats in group, were used in this study. Saline and distilled water treated rats are intact control group. Hyperthyroidism was induced by daily subcutaneous LT4 300 μg/kg treatment for 27 days(LT4 control). Since 12th LT4 treatment PTU(propylthiouracil) 10 mg/kg was intraperitoneal injected(PTU group) and aqueous extracts of Yangkyuksanhwa-tang, Palmulgunja-tang and Cheongpyesagan-tang(YS, PG and CS) 500 mg/kg were orally administrated(YS, PG, CS group), once a day for 15 days. The differences in the body, thyroid gland and epididymal fat pad weights, serum T3(tri-iodothyronine), T4(thyroxine), TSH(thyroid-stimulating hormone), thyroid gland and epididymal fat pad histopathology, liver weight, AST(asparte aminotransferase), ALT(alanine aminotransferase) concentrations, hepatic lipid peroxidation, GSH(glutathione), SOD(superoxide dismutase), CAT(catalase) activities, liver histopathology were observed to evaluate effects on hyperthyroidism, liver damages and antioxidant effects.Results As results of LT4 treatment, hyperthyroidism and related liver damages such as lower body, thyroid weights, higher serum T3, T4, AST, ALT levels, thinner follicular lining epithelium in thyroid glands were observed. However, these symptoms were inhibited by oral treatment of YS, PG and CS. As compared with PTU treatment, these herbal prescriptions showed lower overall efficacy on the hyperthyroidism, but YS showed more favorable effects on the hepatic antioxidant defense systems.Conclusions This results suggest that YS, PG and CS favorably control the LT4 induced hyperthyroidism and related liver damages in rats through modulation of the hepatic antioxidative defense systems.

현삼갑항방(玄參甲亢方)이 Sodium Levothyroxine 투여로 유발된 백서의 갑상선중독증에 미치는 영향

장선규,김철중,조충식,Chang, Sun-Kyu,Kim, Cheol-Jung,Cho, Chung-Sik 대한한방내과학회 2007 大韓韓方內科學會誌 Vol.28 No.1

Objective : This study was to elucidate the effects of Hyunsamkabhangbang (HSK) on the hyperthyroidism induced by sodium levothyroxine. Method : Sprague-Dawley rats were separated into five groups. Except the normal group, the other four groups were treated with sodium levothyroxine 160${\mu}g/kg/day$ for 5 days by oral administration. Among the four groups, all except one (as control) were treated with various concentrations of HSK (0.5, 1.0, 2.0 g/kg/days) for 3 days separately. T3-uptake, T3, T4, TSH, total cholesterol, free fatty acid, ${\beta}$-lipoprotein, glucose, ALP, AST, ALT change in the serum and body weight of rats were measured after medication of solid extract of HSK. Results : HSK decreased significantly serum T3, T4, T3-uptake, ALP, free fatty acid and glucose level in a dose-dependent manner compared with control. HSK increased significantly serum TSH and total cholesterol level and body weight in a dose-dependent manner compared with control. HSK also increased serum ${\beta}$-lipoprotein level compared with control, but not statistically meaningfully. HSK increased significantly serum AST and ALT level compared with control, but relationship to hyperthyroidism is not found. Conclusions : From these results, it could be concluded that HSK lowers excess thyroid hormone and increased metabolism, resulting in improvement of hyperthyroid state.

저용량 경구용 갑상선 호르몬제로 치료한 점액수종 혼수 1예

박민규,이광재,이혜원,심은희,강진두,여창우 대한노인병학회 2013 Annals of geriatric medicine and research Vol.17 No.4

Myxedema coma is a severe life-threatening form of hypothyroidism that is associated with a high mortality rate. It is known to be common in the elderly, and is mainly accompanied with cardiogenic shock, respiratory failure, central nervous system dysfunction, and body temperature regulation defects. Thus, immediate management is required in order to prevent fatal complications in myxedema coma. However, early detection is difficult and further, it is easily misdiagnosed due to its low incidence rate and nonspecific symptoms. We report a case of myxedema coma which was misdiagnosed for heart failure. The patient was successfully treated with intensive care and oral low dose levothyroxine.

휘담식 곡골수기법을 병용한 갑상선기능저하증 1례 증례 보고

배재룡,장상철,필감매,이재흥,안훈모 대한의료기공학회 2020 醫療氣功 Vol.20 No.1

Objective : A common treatment for hypothyroidism is to supplement the deficient hormones. However, taking hormone medication does not improve clinical symptoms or side effects, so it is necessary to develop other improved treatments. The purpose of this study is to report that the Korean medicine treatment along with Whidam’s Gokgol(CV2) Sugi therapy has improved symptoms of hypothyroidism and related the level of TSH, free T4 after halting the use of levothyroxine. Methods : We employed Korean medicine treatment; herbal-medication(延齡固本丹 and 加減平胃散), acupuncture, and cupping therapy, and so forth. At the same time, we treated the patient with Whidam's Sugi therapy(especially, Gokgol Sugi therapy). We treated the patient more than five times a week for the first month and treated more than three times a week for the next three months. Since then, we have treated the patient once or twice a week. The patient took a total of four blood tests during her treatment in 2012 and 2017. Results : 1. Both TSH and free T4 levels and clinical symptoms were normalized for patient with hypothyroidism who stopped taking levothyroxine by treating the patient with Korean medicine treatment and Whidam's Sugi therapy. 2. The combination of Korean medicine treatment and Whidam's Sugi therapy was also used in the case of subclinical hypothyroidism patient. 3. The combination of Korean medicine treatment and Whidam's Sugi therapy for hypothyroidism lasted for five years, not just for a short period of time. Conclusions : The combination of Korean medicine treatment and Whidam's Sugi therapy(especially, Gokgol Sugi therapy) was effective in the treatment of hypothyroidism and it helped to normalize the level of TSH, free T4. It is hoped that further clinical research will continue in the future so that it can be used not only for hypothyroidism but also for other endocrine diseases.

증례 : 내분비-대사 ; 갑상선전절제술을 받은 환자에서 급성 Levothyroxine 중독 1예

정윤 ( Yun Jung ),안희정 ( Hee Jung Ahn ),현진수 ( Jin Soo Hyun ),장회수 ( Hoe Soo Jang ),김진화 ( Jin Hwa Kim ),김상용 ( Sang Yong Kim ) 대한내과학회 2015 대한내과학회지 Vol.88 No.3

The use of levothyroxine is increasingly widespread. There are relatively few reports of acute massive levothyroxine intoxication leading to emergencies in adults, and such intoxication has a wide range of presentations. Although thyroid gland activity is suppressed by thyroid stimulating hormone as a result of overdose exposure to exogenous thyroid hormone, it is unclear what symptoms are to be expected in acute levothyroxine intoxication in the absence of the thyroid gland. We report a case of massive acute levothyroxine intoxication in a patient with total thyroidectomy, along with observed changes over time in thyroid hormone levels and symptoms. To the best of our knowledge, this report presents the first description of acute massive levothyroxine intoxication in the absence of a thyroid gland. (Korean J Med 2015;88:313-317)

갑상선 양성 결절에서 갑상선 호르몬 억제요법의 효과

김윤정,태경,강석영,이용섭,김동선,김태화,안유헌 대한이비인후과학회 2009 대한이비인후과학회지 두경부외과학 Vol.52 No.8

Background and Objectives The effectiveness of suppressive therapy with Levothyroxine in benign thyroid nodule is controversial. The favorable response varies between 9-68%. The aim of this study was to evaluate the effect of Levothyroxine suppressive therapy on benign thyroid nodules in comparison with untreated patients. Subjects and Method A total 98 patients diagnosed with benign thyroid nodules by high resolution ultrasonography and fine needle aspiration cytology from January 2001 to June 2007 was evaluated retrospectively. The case group included 55 patients who received Levothyroxine suppressive therapy for longer than 6 months with documentation of thyroid stimulating hormone (TSH) suppression level. The control group included 43 patients who were followed up without any treatment. We measured TSH, free T4, and thyroid nodule volume by ultrasound every 6 months. Results In 13 patients (23.6%) of the case group, nodule volume decreased more than 50% after the Levothyroxine suppressive therapy. In 10 (23.2%) of the control group, nodule volume decreased more than 50 % after the follow-up of 6 months. There was no significant difference between the two groups. The change of nodule volume was not related to the TSH suppression level, the number of nodule or the type of nodule. Conclusion We concluded that Levothyroxine suppressive therapy was not effective in volume reduction of benign thyroid nodules.