Fanghänel G, Sánchez-Reyes L, Escalante HA, Rangel RI, Torres P, Violante R, Madero FCM

Idioma: Español
Referencias bibliográficas: 41
Paginas: 446-453
Archivo PDF: 250.62 Kb.

RESUMEN

Antecedentes: la levotiroxina sódica trirranurada tiene presentación en comprimidos que garantizan el corte exacto, precisión de la dosis y homogeneidad en cada fracción, lo que permite individualizar la dosis administrada. Es importante la satisfacción del paciente porque podría influir en el apego al tratamiento y, por tanto, en su efectividad.
Objetivo: identificar, en pacientes con hipotiroidismo primario, la dosis correcta inicial y de mantenimiento y valorar la satisfacción del tratamiento, eficacia y seguridad de la levotiroxina sódica trirranurada.
Material y metodo: estudio multicéntrico, prospectivo, abierto, no comparativo y longitudinal al que se incluyeron pacientes de uno y otro sexo con límites de edad de 18 y 75 años. Se administró levotiroxina trirranurada a dosis de 1.6 mcg por kg de peso, independientemente de la dosis y el medicamento previamente administrado. Para la valoración clìnica se utilizó la escala de Zulewski y se aplicó un cuestionario para la valoración de satisfacción con el tratamiento (TSQM por sus siglas en inglés).
Resultados: se incluyeron 85 pacientes de seis centros nacionales. De acuerdo con la valoración clínica inicial y el perfil tiroideo se demostró que 62 pacientes (61%) no se encontraban en adecuado control clínico o químico: 54 por hipofunción y 8 por sobredosis, se cambió a levotiroxina trirranurada y se ajustó la dosis. En la escala de Zulewski se observaron diferencias significativas al comparar los valores obtenidos en la medición basal (3.94 ± 3.94) vs la visita final (1.69 ± 1.56) p‹0.05. Con respecto a las concentraciones de TSH, se observó diferencia significativa en comparación con los valores basales (2.68 ± 5.76) con respecto a los valores de la visita final (1.65 ± 2.5) p‹0.05.
Conclusiones: al identificar en pacientes hipotiroideos la dosis correcta por kilogramo de peso, se logró demostrar que la individualización de la terapéutica permitió obtener un excelente resultado de eficacia de 98.8%.

REFERENCIAS (EN ESTE ARTÍCULO)

1. AACE Thyroid Task Force. American Association of Clinical Endocrinologists medical guidelines for clinical practice for the evaluation and treatment of hyperthyroidism and hypothyroidism. Endocrine Practice 2002;8:457-469.

2. Cárdenas-Ibarra L, et al. Cross-sectional observations of thyroid function in geriatric Mexican outpatients with and without dementia. Archive Gerontol Geriatr 2007;doi:10.1016/j. archger.2007.03.009.

3. Hollowell JG, Steahling NW, Flanders WD, Hannon WH, Gunter EW, et al. Serum TSH, T(4) and thyroid antibodies in the United States population (1988 to 1994): National Health and Nutrition Examination Survey (NHANES III). J Clin Endocrinol Metab 2002;87:489-499.

4. Caroline GP, Roberts P, Ladenson W. Hypothyroidism. Lancet 2004;363:93-803.

5. Sesmilo G. Monitorización del tratamiento con tiroxina en el hipotiroidismo primario y central. Endocrinología y Nutrición 2005;52(7):358-364.

6. Domínguez J, Bevilacqua M, DiBella G, Barbagallo M. Diagnosing and Managing Thyroid Disease in the Nursing Home. J Am Med Dir Assoc 2008;9:9-17.

7. Walsh PJ, Ward L, Burke V, Bhagat Ch, Shiels L, et al. Small Changes in Thyroxine Dosage do not Produce Measurable Changes in Hypothyroid Symptoms, Well-Being, or Quality of Life: Results of a Double-Blind, Randomized Clinical Trial. J Clin Endocrinol Metab 2006;91:2624-2630.

8. Roos A, Linn-Rasker S, Domburg R, Tijssen J, Berghout A. The Starting Dose of Levothyroxine in Primary Hypothyroidism Treatment A Prospective, Randomized, Double-blind Trial. Arch Intern Med 2005;165:1714-1720.

9. Crilly M, Esmail A. Randomised controlled trial of a hypothyroid educational booklet to improve thyroxine adherence. British Journal of General Practice 2005;55:362-368.

10. Kenneth AW. Update on the Management of Hyperthyroidism and Hypothyroidism. Arch Intern Med 2000;160:1067-1071.

11. Zulewski H, Muller B, Exer P, Miserez AR, Staub JJ. Estimation of tissue hypothyroidism by a new clinical score: evaluation of patients with various grades of hypothyroidism and controls. J Clin Endocrinol Metab 1997;82:771-776.

12. Billewicz WZ, Chapman RS, Crooks J, Day ME, Gossage J, Wayne E, et al. Statistical methods applied to the diagnosis of hypothyroidism. Q J Med 1969;38:255-266.

13. AACE Thyroid Task Force. American Association of Clinical Endocrinologists medical guidelines for clinical practice for the evaluation and treatment of hyperthyroidism and hypothyroidism. Endocrine Practice 2002;8:457-469.

14. Cárdenas-Ibarra L, et al. Cross-sectional observations of thyroid function in geriatric Mexican outpatients with and without dementia. Archive Gerontol Geriatr 2007;doi:10.1016/j. archger.2007.03.009.

15. Hollowell JG, Steahling NW, Flanders WD, Hannon WH, Gunter EW, et al. Serum TSH, T(4) and thyroid antibodies in the United States population (1988 to 1994): National Health and Nutrition Examination Survey (NHANES III). J Clin Endocrinol Metab 2002;87:489-499.

16. Caroline GP, Roberts P, Ladenson W. Hypothyroidism. Lancet 2004;363:93-803.

17. Sesmilo G. Monitorización del tratamiento con tiroxina en el hipotiroidismo primario y central. Endocrinología y Nutrición 2005;52(7):358-364.

18. Domínguez J, Bevilacqua M, DiBella G, Barbagallo M. Diagnosing and Managing Thyroid Disease in the Nursing Home. J Am Med Dir Assoc 2008;9:9-17.

19. Walsh PJ, Ward L, Burke V, Bhagat Ch, Shiels L, et al. Small Changes in Thyroxine Dosage do not Produce Measurable Changes in Hypothyroid Symptoms, Well-Being, or Quality of Life: Results of a Double-Blind, Randomized Clinical Trial. J Clin Endocrinol Metab 2006;91:2624-2630.

20. Roos A, Linn-Rasker S, Domburg R, Tijssen J, Berghout A. The Starting Dose of Levothyroxine in Primary Hypothyroidism Treatment A Prospective, Randomized, Double-blind Trial. Arch Intern Med 2005;165:1714-1720.

21. Crilly M, Esmail A. Randomised controlled trial of a hypothyroid educational booklet to improve thyroxine adherence. British Journal of General Practice 2005;55:362-368.

22. Kenneth AW. Update on the Management of Hyperthyroidism and Hypothyroidism. Arch Intern Med 2000;160:1067-1071.

23. Zulewski H, Muller B, Exer P, Miserez AR, Staub JJ. Estimation of tissue hypothyroidism by a new clinical score: evaluation of patients with various grades of hypothyroidism and controls. J Clin Endocrinol Metab 1997;82:771-776.

24. Billewicz WZ, Chapman RS, Crooks J, Day ME, Gossage J, Wayne E, et al. Statistical methods applied to the diagnosis of hypothyroidism. Q J Med 1969;38:255-266.

25. AACE Thyroid Task Force. American Association of Clinical Endocrinologists medical guidelines for clinical practice for the evaluation and treatment of hyperthyroidism and hypothyroidism. Endocrine Practice 2002;8:457-469.

26. Cárdenas-Ibarra L, et al. Cross-sectional observations of thyroid function in geriatric Mexican outpatients with and without dementia. Archive Gerontol Geriatr 2007;doi:10.1016/j. archger.2007.03.009.

27. Hollowell JG, Steahling NW, Flanders WD, Hannon WH, Gunter EW, et al. Serum TSH, T(4) and thyroid antibodies in the United States population (1988 to 1994): National Health and Nutrition Examination Survey (NHANES III). J Clin Endocrinol Metab 2002;87:489-499.

28. Caroline GP, Roberts P, Ladenson W. Hypothyroidism. Lancet 2004;363:93-803.

29. Sesmilo G. Monitorización del tratamiento con tiroxina en el hipotiroidismo primario y central. Endocrinología y Nutrición 2005;52(7):358-364.

30. Domínguez J, Bevilacqua M, DiBella G, Barbagallo M. Diagnosing and Managing Thyroid Disease in the Nursing Home. J Am Med Dir Assoc 2008;9:9-17.

31. Walsh PJ, Ward L, Burke V, Bhagat Ch, Shiels L, et al. Small Changes in Thyroxine Dosage do not Produce Measurable Changes in Hypothyroid Symptoms, Well-Being, or Quality of Life: Results of a Double-Blind, Randomized Clinical Trial. J Clin Endocrinol Metab 2006;91:2624-2630.

32. Roos A, Linn-Rasker S, Domburg R, Tijssen J, Berghout A. The Starting Dose of Levothyroxine in Primary Hypothyroidism Treatment A Prospective, Randomized, Double-blind Trial. Arch Intern Med 2005;165:1714-1720.

33. Crilly M, Esmail A. Randomised controlled trial of a hypothyroid educational booklet to improve thyroxine adherence. British Journal of General Practice 2005;55:362-368.

34. Kenneth AW. Update on the Management of Hyperthyroidism and Hypothyroidism. Arch Intern Med 2000;160:1067-1071.

35. Zulewski H, Muller B, Exer P, Miserez AR, Staub JJ. Estimation of tissue hypothyroidism by a new clinical score: evaluation of patients with various grades of hypothyroidism and controls. J Clin Endocrinol Metab 1997;82:771-776.

36. Billewicz WZ, Chapman RS, Crooks J, Day ME, Gossage J, Wayne E, et al. Statistical methods applied to the diagnosis of hypothyroidism. Q J Med 1969;38:255-266.

37. Saravanan P, Chau WF, Roberts N, Vedhara K, Greenwood R, Dayan CM. Psychological well-being in patients on 'adequate' doses of l-thyroxine: results of a large, controlled communitybased questionnaire study. Clin Endocrinol (Oxf) 2002;57:577- 585.

38. López J, Rodríguez R. Adaptación y validación del instrumento de calidad de vida en 39 pacientes mexicanos con diabetes mellitus tipo 2. Salud Pública de México 2006;48:200-211.

39. Patel H, Stalcup A, Dansereau R, Sakr A. The effect of excipients on the stability of levothyroxine sodium pentahydrate tablets. International Journal of Pharmaceutics 2003;264: 35-43.

40. Atkinson MJ, Sinha A, Hass SL, Colman SS, Kumar RN, Brod M, et al. Validation of a general measure of treatment satisfaction the Treatment Satisfaction Questionnaire for Medication (TSQM) using a national panel study of chronic disease. Health Qual Life Outcomes 2004;2:12.

41. Bradley C. The Diabetes Treatment Satisfaction Questionnaire (DTSQ). In: Bradley C, editor. Handbook of psychology and Diabetes: A Guide to psychological measurement in Diabetes Research and Practice. Switzerland: Harwood Academic Publishers, 1994;111-132.