甲状腺ホルモンの非経口的補充療法

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Because of the development in parenteral nutrition, the replacement of thyroid hormones in hypothyroid or athyreotic patients under intravenous hyperalimentation has become a new problem to be considered. We tried parenteral replacement of the hormones, intravenously or by enema, in three such patients. Two patients, 54 y-o and 64 y-o females, who underwent laryngo-esophago-thyroidectomy for cervical esophageal cancer or thyroid cancer, had replacement with intravenous l-thyroxine with an initial dose of 100 μg/day for 9 and 22 days, respectively. Another patient, a 56 y-o female with dysphagia due to local recurrence of cervical esophageal cancer after laryngo-esophago-thyroidectomy, was given 100 mg of desiccated thyroid by enema for 8 days followed by intravenous l-thyroxine for 104 days. Serum levels of thyroxine, triiodothyronine and TSH before l-thyroxine treatment indicated severe hypothyroidism in all cases. During the first 7 days of the intravenous therapy, serum thyroxine and triiodothyronine levels increased by 0.87 ± 0.14 μg/di/day and 6.7 ± 4.7 μg/dl/day, respectively, while serum TSH levels decreased by 7.8 ± 6.4 μU/ml/day. Plasma T4 levels reached the normal level within 7 days, and plasma T3 levels within 11 days, while it took 14 days for plasma TSH levels to decrease to the normal level. The maintenance dose checked by the normal TSH levels in a patient undergoing a long term therapy was 75 μg/day or 1.83 μg/kg of body weight/day. After the enema of desiccated thyroid for 8 days, plasma T4 levels increased from 1.6 μg/dl of the initial level to 3.4 μg/dl, and plasma T3 levels increased from 35 μg/dl to 102 μg/dl, while plasma TSH levels decreased from more than 160 μU/ml to 87 μU/ml, suggesting that thyroid hormones administered by enema were absorbed. Replacement therapy with intravenous l-thyroxine was satisfactory. Desiccated thyroid by enema may be worthwhile trying if l-thyroxine preparation for injection is not available.
一般社団法人日本内分泌学会の論文

甲状腺ホルモンの非経口的補充療法

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