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2022, vol. 73, br. 1, str. 43-48
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Analiza farmakoterapijskog pristupa kod pacijenata obolelih od hipertireoze
Analysis of pharmacotherapeutic approach in patients with hyperthyroidism
aUniverzitet u Beogradu, Medicinski fakultet bUniverzitet u Beogradu, Medicinski fakultet + Klinički centar Srbije, Klinika za endokrinologiju dijabetes i bolesti metabolizma, Beograd cUniverzitet u Beogradu, Medicinski fakultet + Univerzitet u Beogradu, Medicinski fakultet, Institut za farmakologiju, kliničku farmakologiju i toksikologiju
e-adresa: adjokicanna@gmail.com
Sažetak
Uvod: Hipertireoza je stanje koje nastaje usled povećane sinteze tireoidnih hormona (T3, T4). U 90% slučajeva nastaje usled Grejvsove bolesti, toksične polinodozne strume i toksičnog adenoma. Terapija hipertireoze može da bude medikamentozna, radioaktivnim jodom ili hirurška. Osnovni antitireoidni lekovi pripadaju grupi tioamida (tiamazol i propiltiouracil). Cilj: Cilj ovog rada bio je da se analizira preoperativni farmakoterapijski pristup sa upotrebom tri preparata iz grupe tioamida (PTU® (propiltiouracil), Thyrozol® (tiamazol) i Tiastat® (tiamazol)), u odnosu na demografske i kliničke karakteristike pacijenata obolelih od hipertireoze. Materijal i metode: Istraživanje je sprovedeno kao retrospektivna studija kojom su obuhvaćena 62 pacijenta starosne dobi od 18 do 84 godine, koja su se javila Centru za endokrinu hirurgiju Univerzitetskog kliničkog centra Srbije (UKCS) zbog operativnog rešavanja hipertireoze u periodu 2014-2019. Rezultati: Grejvsovu bolest imalo je 35,48%, polinodoznu toksičnu stumu 32,26%, a toksični adenom 32,26% pacijenata. Skoro polovina (45,16%) pacijenata koristila je Tiastat®, 29,03% PTU®, a 25,8% Thyrozol®. Najveći broj pacijenata obolelih od Grejvsove bolesti preoperativno je uzimao Tiastat®. U grupi obolelih od toksičnog adenoma najveći broj je koristio PTU®, a u grupi obolelih od toksične polinodozne strume - Tiastat®. Lek PTU® najviše je korišćen u dozi 100 mg/dan, Tiastat® u dozi od 20 mg/dan, a Thyrozol® u dozi od 20 i 30 mg/dan. Totalna tireoidektomija je najčešće izvođena kod pacijenata na terapiji Tiastatom®, a hemitireoidektomija kod onih na terapiji PTU®. Uočeno je da postoji statistički značajna razlika (p < 0,05) u korišćenju pojedinačnih lekova u odnosu na dijagnozu, ukupnu dnevnu dozu leka, indeks telesne mase i vrstu operativnog zahvata. Zaključak: Najveći broj pacijenata je preoperativno koristio Tiastat®. Farmakoterapijski pristup kod obolelih od hipertireoze u skladu je sa smernicama nacionalnog vodiča.
Abstract
Introduction: Hyperthyroidism represents a condition that occurs due to increased synthesis of thyroid hormones (T3, T4). In 90% of all cases it is caused by: Graves' disease, toxic multinodular goiter and toxic adenoma. Therapy of hyperthyroidism includes medication, radioiodine treatment and surgery. The most prescribed antithyroid drugs belong to the thioamide group (thiamazole and propylthiouracil). Aim: The aim of this study was to analyze the preoperative pharmacotherapeutic approach with the use of 3 drugs from the thioamide group (PTU® (propylthiouracil), Thyrozol® (thiamazole) and Tiastat® (thiamazole) in relation to the demographic and clinical characteristics of patients with hyperthyroidism. Material and methods: The study was conducted as a retrospective study among 62 patients aged 18 to 84 years, who reported to the Center for Endocrine Surgery KCS for the operative treatment of hyperthyroidism in period 2014-2019. Results: Diagnosis of Graves' disease was detected in 35.48% of patients, where 32.26% had toxic multinodular goiter, and 32.26% toxic adenoma. The most patients were prescribed Tiastat® (45.16%), 29.03% of them were prescribed PTU®, and 25.8% of them Thyrozol®. The most of patients suffering from Graves' disease were treated with Tiastat®, those suffering from toxic adenoma with PTU® and toxic multinodular goiter with Tiastat®. The most commonly used doses were 100 mg/day for PTU®, 20 mg/day for Tiastat® and 20 and 30 mg/ day for Thyrozol®. Total thyroidectomy is most commonly performed in patients treated with Tiastat® and hemithyroidectomy in those treated with PTU®. It was observed that there was a statistically significant difference (p < 0.05) in the use of individual drugs regarding to diagnosis, total daily dose of drug, body mass index and type of surgical procedure. Conclusion: The most of patients were prescribed Tiastat®. Pharmacotherapeutic approach in paients with hyperthyroidism is in accordance with the national guidelines.
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