Changes of Thyroid Hormone Levels in Patients with Grave's Hyperthyroidism Receiving Cholestyramine Adjunctive Therapy

Cholestyramine輔助性治療對格雷夫氏甲腺高能症患者甲腺功能變化之影響

廖文魁(Wen-Kuei Liao) ； 郭熙文(Shi-Wen Kuo) ； 黃文盛(Wen-Sheng Huang) ； 鄭啟源(Chii-Yuan Jeng) ； 傅茂祖(Martin M-T Fuh)

《Journal of Medical Sciences》 15卷3期 (1994/12) Pp. 163-170

摘要

Current treatment of Graves' hyperthyroidism often includes the use of antithyroid drugs (e.g. propylthiouracil, methimazole) which usually restore euthyroidism in 1-3 months. In view of the increased enterohepatic circulation of thyroxine (T4) and triiodothyronine (T3) in hyperthyroidism, cholestyramine, a bile acid sequestrant resins, when used adjunctively with methimazole and betablocker, would lower serum iodothyronine levels faster than would standard therapy alone. Twenty patients with Graves' hyperthyroidism were' divided into two groups: group A (n= 10) received methimazole 30 mg, propranolol 120 mg and cholestyramine 15 gm daily for two weeks; group B (n=10, matched sex, age, and initial thyroid hormone levels with group A received methimazole 30 mg and propranolol 120 mg daily for two weeks. The results showed: (1) The achievement of euthyroidism was noted after combination therapy for two weeks in group A patients; (2) A more rapid decline in all thyroid hormone levels (T3, T4, free T4, but not TSH) was seen in the cholestyramine-treated group A than in group B (p＜0.05, week one and two, respectively); (3) TSH receptor antibody levels remained unaffected regardless of group, treatment, or time. We conclude that cholestyramine is a safe and effective adjunctive agent in the treatment of Graves' hyperthyroidism and that its greatest efficacy may be during the first weeks of treatment.

關鍵字

格雷夫氏甲狀腺高能症

並列摘要

Current treatment of Graves' hyperthyroidism often includes the use of antithyroid drugs (e.g. propylthiouracil, methimazole) which usually restore euthyroidism in 1-3 months. In view of the increased enterohepatic circulation of thyroxine (T4) and triiodothyronine (T3) in hyperthyroidism, cholestyramine, a bile acid sequestrant resins, when used adjunctively with methimazole and betablocker, would lower serum iodothyronine levels faster than would standard therapy alone. Twenty patients with Graves' hyperthyroidism were' divided into two groups: group A (n= 10) received methimazole 30 mg, propranolol 120 mg and cholestyramine 15 gm daily for two weeks; group B (n=10, matched sex, age, and initial thyroid hormone levels with group A received methimazole 30 mg and propranolol 120 mg daily for two weeks. The results showed: (1) The achievement of euthyroidism was noted after combination therapy for two weeks in group A patients; (2) A more rapid decline in all thyroid hormone levels (T3, T4, free T4, but not TSH) was seen in the cholestyramine-treated group A than in group B (p＜0.05, week one and two, respectively); (3) TSH receptor antibody levels remained unaffected regardless of group, treatment, or time. We conclude that cholestyramine is a safe and effective adjunctive agent in the treatment of Graves' hyperthyroidism and that its greatest efficacy may be during the first weeks of treatment.

並列關鍵字

Cholestyramine ； Graves' hyperthyroidism ； methimazole