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治療抵抗性甲状腺機能低下症および吸収不良に対する毎日の筋肉内レボチロキシン
Thanh D Hoang1,2, Thuy D Le1, Phong N Truong1,2
1Division of Endocrinology, Department of Medicine, Walter Reed National Military Medical Center, Bethesda, Maryland.
AACE endocrinology and diabetes
|December 30, 2025
まとめ
経口レボチロキシン(LT4)に抵抗性のある甲状腺機能低下症の患者にとって、注射用LT4は実行可能な代替手段となる。この症例報告では、毎日の筋肉内(IM)LT4を使用して持続的な甲状腺機能低下症を治療し、甲状腺刺激ホルモン(TSH)レベルを正常化し、症状を解消した成功例を詳述している。
科学分野:
- 内分泌学
- 薬理学
- 内科学
背景:
- レボチロキシン(LT4)単独療法は甲状腺機能低下症の標準治療である。
- 標準治療が効果的でない場合は、代替治療が検討される。
- 胃バイパス手術は甲状腺ホルモンの吸収に影響を与える可能性がある。
主な方法:
- 橋本病の55歳女性は、胃バイパス手術後に持続的な甲状腺機能低下症を経験した。
- 複数の経口LT4および乾燥甲状腺製剤レジメンでは、甲状腺刺激ホルモン(TSH)レベルを正常化できなかった。
- 甲状腺ホルモン吸収試験により、経口バイオアベイラビリティが著しく低下していることが明らかになった。
- 毎日の筋肉内(IM)LT4(100 mcg)で治療を開始した。
結論:
- 筋肉内(IM)レボチロキシン(LT4)は、経口吸収障害のある甲状腺機能低下症患者の治療選択肢となり得る。
- これは、治療抵抗性の甲状腺機能低下症に対するIM LT4を用いた毎日の外来治療の成功を示す最初の症例報告である。
- 甲状腺機能低下症の管理におけるIM LT4の有効性と安全性をさらに調査するための研究が必要である。
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