Anti-Tiroid İlaçlar Ne Kadar Güvenilir?
Synopsis
Anti-tiroid ilaçlar 50 yılı aşkın bir süredir tirotoksikoz tedavisinde yaygın bir şekilde kullanılmaktadır. Bu ilaçlar tiyonamid grubu ilaçlar olarak bilinen propiltiyourasil (PTU) ve methimazole olup, tiroid hormon sentezini inhibe ederek etki göstermektedirler. Bu ilaçların kullanımına bağlı olarak minor ve major yan etkiler görülebilmektedir. Bu makalede PTU ve methimazol kullanımı sonrası ortaya çıkan major iki adet yan etki vakası sunularak bu ilaçları kullananan hastalarda klinisyenlerin daha dikkatli olmaları konusuna vurgu yapılmıştır.
Antithyroid drugs have been widely used in the treatment of thyrotoxicosis for over 50 years. These drugs are propylthiouracil (PTU) and methimazole, known as thionamide group drugs, and they act by inhibiting thyroid hormone synthesis. Minor and major side effects can be seen depending on the use of these drugs. In this article, two major side effect cases that occurred after the use of PTU and methimazole are presented and it is emphasized that clinicians should be more careful in patients using these drugs.
References
Burch HB, Cooper DS. Anniversary Review: Antithyroid drug therapy: 70 years later. Eur J Endocrinol 2018;179:R261-74. 10.1530/EJE-18-0678.
Abdi H, Amouzegar A, Azizi F. Antithyroid Drugs. Iran J Pharm Res. 2019 Fall;18(Suppl1):1-12.
Jiang X, Khursigara G, Rubin RL. Transformation of lupus-inducing drugs to cytotoxic products by activated neutrophils. Science 1994; 266: 810-3.
Von Schmiedeberg S, Goebel C, Gleichmann E, Uetrecht J. Neutrophils and drug metabolism [letter] Science 1995; 268: 585-6.
Lee E, Miki Y, Katsura H, Kariya K. Mechanism of inactivation of myeloperoxidase by propylthiouracil. Biochem Pharmacol 1990; 39: 1467-71.
Hirata Y, Ishizu H, Ouchi N, Hara Y. Wakasugi Het al. Insulin autoimmunity in a case with spontaneous hypoglycemia. J Jpn Diabetes Soc.1970; 13: 312-20.
Lupsa BC, Chong AY, Cochran EK, Soos MA, Semple RK et al. Autoimmune forms of hypoglycemia. Medicine (Baltimore) 2009; 88: 141-53.
Roh E, Kim YA, Ku EJ, Bae JH, Kim HM et al. Two cases of methimazole-induced insulin autoimmune syndrome in graves’ disease. Endocrinol Metab (Seoul) 2013; 28: 55-60.
Ichihara K, Shima K, Saito Y, Nonaka K, Tarui S. Mechanism of hypoglycemia observed in a patient with insulin autoimmune syndrome. Diabetes.1977; 26: 500- 6.
Redmon JB, Nuttall FQ. Autoimmune hypoglycemia. Endocrinol Metab Clin North Am. 1999; 28: 603-18.
Eisenbarth GS. Immunoendocrinology: scientific and clinical aspects. Totowa: Springer Science+Business Media Chapter 21. Insulin autoimmune syndrome (Hirata disease). 2011; 343-7.
