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[Combined l-thyroxine and l-triiodothyronine replacement therapy in congenital hypothyroidism].
Orv Hetil 2013; 154(19):738-44OH

Abstract

INTRODUCTION

L-thyroxine replacement therapy is the treatment of choice for hypothyroidism. Recently, several studies suggested to complete it with l-triiodothyronine in acquired hypothyroidism.

AIM

To study the role of combined l-thyroxine and l-triiodothyronine therapy in special cases with congenital hypothyroidism.

METHOD

Data of 16 patients (age: 11.9 ± 6.3 years; mean ± SD) are presented who had high serum free thyroxine values or even above the upper limit of reference range (21.16 ± 2.5 pmol/l) together with nonsuppressed TSH levels (15.7 ± 5.7 mIU/l), and therefore received l-triiodothyronine in completion (0.18 ± 0.09 μg/kg) once a day.

RESULTS

The combined replacement therapy resulted in a rapid improvement of the hormone parameters (TSH: 4.2 ± 3.15 mIU/l; free thyroxine: 16.55 ± 2.4 and free triiodothyronine: 7.4 ± 1.8 pmol/l). The efficiency of this combined therapy proved to be more evident (TSH: 4.33 ± 3.2 mIU/l; free thyroxine: 16.85 ± 3.1 and free triiodothyronine: 6.4 ± 0.85 pmol/l) in 10 patients treated for a longer period of time (duration of treatment: 2.9 ± 2.0 years). The dose of thyroxine substitution decreased from 2.6 ± 0.9 to 2.18 ± 0.6 μg/kg/day), the ratio of these hormones was between 5:1 and 19:1 and the quotient of free fractions was normalized (3.8 ± 0.4→2.6 ± 0.3) during the replacement therapy.

CONCLUSIONS

According to the observation of the authors a serious disturbance of feed-back mechanism may develop in some (>5%) children with congenital hypothyroidism (increased TSH release despite elevated free thyroxine level) after normal function of the feed-back system for years. Hormone parameters of these patients improve, then become normal on combined therapy supporting the rationale for this treatment method.

Authors+Show Affiliations

Szent János Kórház és Észak-budai Egyesített Kórházai Budai Gyermekkórház részleg Budapest Bolyai u. 5-9. 1023. peter_f@budaigyk.huNo affiliation info available

Pub Type(s)

English Abstract
Journal Article

Language

hun

PubMed ID

23649638

Citation

Péter, Ferenc, and Agota Muzsnai. "[Combined L-thyroxine and L-triiodothyronine Replacement Therapy in Congenital Hypothyroidism]." Orvosi Hetilap, vol. 154, no. 19, 2013, pp. 738-44.
Péter F, Muzsnai A. [Combined l-thyroxine and l-triiodothyronine replacement therapy in congenital hypothyroidism]. Orv Hetil. 2013;154(19):738-44.
Péter, F., & Muzsnai, A. (2013). [Combined l-thyroxine and l-triiodothyronine replacement therapy in congenital hypothyroidism]. Orvosi Hetilap, 154(19), pp. 738-44. doi:10.1556/OH.2013.29599.
Péter F, Muzsnai A. [Combined L-thyroxine and L-triiodothyronine Replacement Therapy in Congenital Hypothyroidism]. Orv Hetil. 2013 May 12;154(19):738-44. PubMed PMID: 23649638.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - [Combined l-thyroxine and l-triiodothyronine replacement therapy in congenital hypothyroidism]. AU - Péter,Ferenc, AU - Muzsnai,Agota, PY - 2013/5/8/entrez PY - 2013/5/8/pubmed PY - 2013/7/3/medline SP - 738 EP - 44 JF - Orvosi hetilap JO - Orv Hetil VL - 154 IS - 19 N2 - INTRODUCTION: L-thyroxine replacement therapy is the treatment of choice for hypothyroidism. Recently, several studies suggested to complete it with l-triiodothyronine in acquired hypothyroidism. AIM: To study the role of combined l-thyroxine and l-triiodothyronine therapy in special cases with congenital hypothyroidism. METHOD: Data of 16 patients (age: 11.9 ± 6.3 years; mean ± SD) are presented who had high serum free thyroxine values or even above the upper limit of reference range (21.16 ± 2.5 pmol/l) together with nonsuppressed TSH levels (15.7 ± 5.7 mIU/l), and therefore received l-triiodothyronine in completion (0.18 ± 0.09 μg/kg) once a day. RESULTS: The combined replacement therapy resulted in a rapid improvement of the hormone parameters (TSH: 4.2 ± 3.15 mIU/l; free thyroxine: 16.55 ± 2.4 and free triiodothyronine: 7.4 ± 1.8 pmol/l). The efficiency of this combined therapy proved to be more evident (TSH: 4.33 ± 3.2 mIU/l; free thyroxine: 16.85 ± 3.1 and free triiodothyronine: 6.4 ± 0.85 pmol/l) in 10 patients treated for a longer period of time (duration of treatment: 2.9 ± 2.0 years). The dose of thyroxine substitution decreased from 2.6 ± 0.9 to 2.18 ± 0.6 μg/kg/day), the ratio of these hormones was between 5:1 and 19:1 and the quotient of free fractions was normalized (3.8 ± 0.4→2.6 ± 0.3) during the replacement therapy. CONCLUSIONS: According to the observation of the authors a serious disturbance of feed-back mechanism may develop in some (>5%) children with congenital hypothyroidism (increased TSH release despite elevated free thyroxine level) after normal function of the feed-back system for years. Hormone parameters of these patients improve, then become normal on combined therapy supporting the rationale for this treatment method. SN - 0030-6002 UR - https://www.unboundmedicine.com/medline/citation/23649638/[Combined_l_thyroxine_and_l_triiodothyronine_replacement_therapy_in_congenital_hypothyroidism]_ L2 - http://www.akademiai.com/doi/full/10.1556/OH.2013.29599?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -