Актуальные вопросы заместительной терапии гипотиреоза


Фадеев В.В., Моргунова Т.Б.

Манифестный гипотиреоз является абсолютным показанием к назначению заместительной терапии препаратами тиреоидных гормонов. Согласно современным рекомендациям, “золотым стандартом” для такой терапии является левотироксин. Назначение заместительной терапии при гипотиреозе требует тщательного подбора дозы препарата, а после достижения компенсации – динамического наблюдения с контролем уровня ТТГ. В статье рассматриваются основные проблемы заместительной терапии гипотиреоза, связанные с узким терапевтическим диапазоном левотироксина, сопутствующим применением других лекарственных средств, разной приверженностью пациентов лечению и др. Особое внимание уделено вопросу биоэквивалентности различных препаратов левотироксина.

Литература






  1. Bhasin S, Cunningham GR, Hayes FJ, et al. Testosterone therapy in adult men with androgen deficiency syndromes: an endocrine society clinical practice guideline. J Clin Endocrin Metab 2006;91(6):1995–2010.

  2. Clinical guidelines “Testosterone Therapy in Adult Men with Androgen Deficiency Syndromes”. 2006:3.

  3. Feldman HA, Longcope C, Derby CA, et al. Age trends in the level of serum testosterone and other hormones in middle-aged men; longitudinal results from the Massachusetts Male Aging Study. J Clin Endocrinal Metab 2002;87:589–98.

  4. Shabsigh R. Testosterone Replacement Therapy for the Management of Male Hypogonadism With Associated Comorbidities. Med site CME, 2007.

  5. Swerdloff RS, Wang C, Cunningham G, et al. Long-term pharmacokinetics of transdermal testosterone gel in hypogonadal men. J Clin Endocrin Metab 2000;85:4500–10.

  6. Spratt DI, O'Dea LS, Schenfeld D, et al. Neuroendocrine-gonadal axis in men, frequent sampling of LH, FSH, and testosterone. Am J Physiol 1998;254:E658–E666.

  7. Каррузерс М. Революция тестостерона. М., 2005.

  8. Arver S, Sinha-Hikim I, Beall G, et al. Serum dihydrotestosterone and testosterone concentrations in human immunodeficiency virus-infected men with and without weight loss. J Androl 1999;20:611–18.

  9. Bleisener N, Albrecht S, Schwager A, et al. Plasma testosterone and sexual function in men receiving buprenorphine maintenance for opiod dependence. J Clin Endocrinol Metab 2005; 90:203–06.

  10. Dobs AS, Few WL, Blackman MR, et al. Serum hormones in men with human immunodeficiency virus associated wasting. J Clin Endoc Metab 1996;81:4108–12.

  11. Riggs BL, Khosla S, MElton LJ. Sex steroids and the construction and conservation of the adult skeleton. Endocr Rev 2002;23:279–302.

  12. Mauras N, Hayes V, Welch S, et al. Testosterone deficiency in young men: marked alterations in whole body protein kinetics, strength, and adiposity. J Clin Endocrinol Metab 1998;83:1886–92.

  13. Bhasin S, Woodhouse L, Casaburi R, et al. Testosterone dose-response relationships in healthy young men. Am J Physiol Endocrinol Metab 2001;281:E1172–E1181.

  14. Fowler JE, Whitmore WF. The response of metastatic adenocarcinoma of the prostate to exogenous testosterone. J Urol 1981;126:372–75.

  15. Calof OM, Singh AB, Lee ML, et al. Adverse events associated with testosterone replacement in middle-aged and older men: a meta-analysis of randomized, placebo-controlled trials. J Gerontol A Boil Sci Med Sci 2005;60:1451–57.

  16. Reihman M, Rhodes PR, Cook TD, et al. Analysis of variation in prostate-specific antigen values. Urology 1993;42:390–97.

  17. Bhasin S, Singh AB, Mac RP, et al. Managing the risks of prostate disease during testosterone replacement therapy in older men: recommendations far a standardized monitoring plan. J Androl 2003;24:299–311.

  18. Bancroft J. Hormones and hhuman sexual behaviour. Br Men Bull 1981;37:153–58.

  19. Wang C, Swedloff RS, Iranmanesh A, et al. Transdermal testosterone gel improves sexual function, mood, muscle strength, and body composition parameters in hypogonadal men. Testosterone Gel study group. J Clin Endocrinol Metab 2000;86:2839–53.

  20. Wang C, Gunninham G, Dobs A, et al. Long-term testosterone gel (AndroGel) treatment maintains beneficial effects on sexual function and mood, lean and fat mass, and bone mineral density in hypogonadal men. J Clin Endocr Metab 2004;89:2085–98.

  21. Yassin AA, Saad F. Treatment of sexual dysfunction of hypogonadal patients with long-action testosterone undecanoate (nebido). World J Urol 2006;24(6):639–44.

  22. Morrales A, Neischlag E, Schubert M, et al. Clinical experience with the new long-acting injectable testosterone undecanoate. Report on the educational symposium on the occasion of the 5th world congress on the aging male. 2006;9:221–27.

  23. Neischlag E, Buchter D, Von Eckardstein S, et al. Repeated intramuscular injections of testosterone undecanoate for substitution therapy in hypogonadal men. J Clin Endocrinol 1999;51: 757–63.

  24. Eckardstein S, Bieschlag E. Treatment of male hypogonadism with testosterone undecanoate injected at extended intervals of 12 weeks: a phase 2 study. J Androl 2002;23:419–25.

  25. Minnemann T, Schubert M, Christoph A, et al. Intramuscular testosterone undecanoate: experience over 30 month of therapy. Exp Clin Endocr Diabetes 2003;111:S1–S78.

  26. Jockenhovel F. Male hypogonadism – Practical aspect of androgen therapy. Bremen, Germany Uni-Med Verga: 2004.

  27. Wnag C, Swerdloff R, Kipnes M, et al. New testostosterone buccal system (Striant) delivers physiological testosteorone levels: pharmacokinetics study in hypogonadal men. J Clin Endocrinol Metab 2004;89:3821–29.

  28. Bacon CG, Hu FB, Giovannucci E, et al. Association of type and duration of diabetes with erectile dysfunction in a large cohort of men. Diabetes Care 2002;25(8):1458–63.

  29. Boulton AJ, Selam JL, Sweeney M, et al. Sildenafil citrate for the treatment of erectile dysfunction in men with Type II diabetes mellitus. Diabetologia 2001;44(10):1296–301.

  30. Feldman HA, Goldstein I, Hatzichristou DG, et al. Impotence and its medical and physical the Massachusetts male aging study. J Urol 1994;151: 54–61.

  31. Billups KL, Bank AJ, Padma-nNathan H, et al. Erectile dysfunction is a marker for cardiovascular desiese. J Sex Med 2005;2:438–44.

  32. Shiri R, Koskimaki J, Hakkinen J, et al. Cardivascular drug use and the incidence of erectile dysfunction. Int J Impot Res 2007;19(2):208–12.

  33. Carani C, Scuteri A, Marrama P, et al. The effects of testosterone administration and visual erotic stimuli on posturnal penile tumescence in normal men. Horm Behav 1990;24:435–41.

  34. Carani C, Bancroft J, Granata A, et al. Testosterone and erectile function, nocturnal penile tumescense and rigidity, and erectile response to visual erotic stimuli in hypogonadal and eugonadal men. Psychoneuendocrinology 1992;17:647–54.

  35. Singh AB, Hsia S, Alaupovic P, et al. The effect of varying doses of T on usulin sensitivity, plasma lipids, apolipoproteins, and C-reactive protein in healthy young men. J Clin Endocr Metab 2002;87:136–43.

  36. Clopper PR, Voorhess ML, MacGillivray MH, et al. Psychosexual behavior in hypopituitary men: a controlled camparison of gonadotropin and testosterone replacement. Psychoneuroendocrinology 1993;18:149–61.

  37. Stuckey BG, Jadzinsky MN, Murphy LJ, et al. Sildenafil citrate for treatment of erectile dysfunction in men with type 1 diabetes: results of a randomized controlled trial. Diabetes Care 2003;26(2):279–84.

  38. Aversa A, Isidori AM, Spera G, et al. Androgens improve cavernous vasodilatation and response to sildenafil in patients with erectile dysfunction. Clin Endocr 2003;58:632–38.

  39. Vernet D, Cai L, Garban H, et al. Reduction of penile nitric oxide synthase in diabetic BB/WOR (type 1) and BBZ/WOR (type 2) rats with erectile dysfunction. Endocrinology 1995;136:5709–17.

  40. Jain P, Rademaker AW, Mcvary KT. Testosterone supplementation for erectile dysfunction in men: a controlled study. Br J Psychiatry 2000;145:146–51.

  41. Amory JK, Watts NB, Easley KA, et al. Exogenous testosterone or testosterone with finasteride increases bone mineral density in older men with low serum testosterone. J Clin Endocrin Metab 2004;89:503–10.




Бионика Медиа