Lithium用於甲狀腺腫.pptVIP

Lithium用於Graves Disease 主講人:郭人瑚 指導藥師：張美琪 99/7/29 Question Patient History Objective Family history of thyroid disease Thyroid Gr1-2 diffuse firm goiter, combine Graves disease Palpitation, proximal muscle weakness , menstral cycle : irregular, stool passage increased, soft loose stool Drug profile Lab Data Outline 何謂Graves Disease 臨床表徵及診斷 治療 What is Graves’ Disease? Disease in which the immune system attacks the thyroid gland, causing the thyroid gland to react by making too much thyroid hormone. The over-activity of a thyroid gland is referred to as hyperthyroidism. Graves Disease Causes of Graves’ Disease Genetic tendencies of the immune system to attack itself Stress Symptoms Diagnosed Treatment Anti-thyroid drugs Make it harder for the thyroid gland to create hormones by decreasing the thyroid gland’s ability to use iodine Radio active iodine: iodine 131 Impairs thyroid cells, thereby reducing the amount of thyroid hormone produced Surgery Removal of the majority of the thyroid gland Treatment 主要藥物治療 Antithyroid drugs methimazole propylthiouracil Treatment 輔助治療- β-blocker Lithium Glucocorticoids inhibit peripheral T4 to T3 conversion and, reduce thyroid secretion. They have been used in patients with severe hyperthyroidism and thyroid storm, although their efficacy is not well demonstrated Lithium用於Graves Disease的治療 機轉: 作用機轉相似於碘 Lithium acts by inhibiting T4 and T3 release from the thyroid and possibly also by inhibiting their synthesis. Evidence Micromedex FDA Approval: Adult, no; Pediatric, no Efficacy: Adult, Evidence is inconclusive Recommendation: Adult, Class III Strength of Evidence: Adult, Category B Use of lithium in the treatment of thyrotoxicosis Patients: 13名等候以放射性碘或施手術的病人 (對Antithyroid drugs 治療有不良反應或對此藥療效不佳) Dosage : 500-1500 mg/day 血清中濃度0.63 mmol/L Results: 有八名病患對lithium治療反應滿意,且均在1-2星期內FT4減少