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ISSN 0188-9796 (Impreso)

2011, Número 1

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Rev Endocrinol Nutr 2011; 19 (1)


Tratamiento de las principales formas de tirotoxicosis. Tiocarbamidas y cirugía (primera de dos partes)

Bolaños-Gil de Montes F, Rangel-Sánchez G, Navarro-Hermosillo L

Idioma: Español
Referencias bibliográficas: 53
Paginas: 21-30
Archivo PDF: 100.38 Kb.


RESUMEN

Actualmente no contamos con un tratamiento etiológico específico y sin efectos secundarios para las principales causas de tirotoxicosis, especialmente su forma más frecuente, el hipertiroidismo autoinmune. Los principales recursos terapéuticos para el tratamiento del hipertiroidismo, especialmente el autoinmune, actúan impidiendo la síntesis de hormonas tiroideas (tiocarbamidas) o produciendo ablación de buena parte de la glándula (cirugía y yodo radiactivo). En relación con las principales tendencias terapéuticas en los Estados Unidos y en nuestro país, se prefiere el uso del yodo radiactivo, mientras que en Europa y Japón se opta por las tiocarbamidas, que producen remisión del hipertiroidismo autoinmune en 30 a 50% de los casos; por ello, en este último caso, es imperativo seleccionar a los pacientes con más posibilidad de remisión (género femenino, bocio pequeño, sin exoftalmos y con anticuerpos estimulantes del receptor de tirotrofina a títulos bajos). Otras indicaciones de las tiocarbamidas son la población pediátrica, la preparación para cirugía, entre dos dosis de yodo radiactivo y en la crisis tiroidea. A este respecto, se ha incrementado el uso del yodo radiactivo en pediatría. Dado el potencial del propiltiouracilo para producir daño hepático, incluso fulminante, la ATA (American Thyroid Association) recomienda limitar su uso al primer trimestre del embarazo, en la crisis tiroidea y cuando existen efectos tóxicos por el metimazol, exceptuando a la agranulocitosis. Las indicaciones quirúrgicas en el hipertiroidismo son la existencia de compresión, motivos estéticos o lesión tiroidea maligna. Dado que ninguna forma de tratamiento es la ideal, la decisión terapéutica deberá ser individualizada y decidida en forma conjunta con el paciente.


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