Hipotiroidismo refractario al tratamiento
DOI:
https://doi.org/10.18041/2665-427X/ijeph.2.9905Palabras clave:
Hipotiroidismo, levotiroxina, malabsorción, hipotiroidismo refractario, refractario, LT4, hormona tiroideaResumen
Introducción: El hipotiroidismo refractario es una entidad en la cual, los pacientes requieren dosis elevadas de hormona tiroidea, persistiendo con los síntomas de hipotiroidismo y con niveles de hormona estimulante de tiroides (TSH) alta, representando un desafío para el clínico. La compresión de sus causas permite un mejor abordaje diagnóstico y así mismo evita la sobredosificación y efectos adversos de la misma.
Objetivo: Presentar los conceptos clave que ayuden a identificar las causas de la refractariedad al tratamiento, incluyendo adherencia, malabsorción o incremento en la demanda de la hormona tiroidea.
Métodos: Se realizo una búsqueda de los principales conceptos a acerca de las causas, el diagnóstico y tratamiento de hipotiroidismo refractario, de acuerdo con la revisión presentada en el congreso de la asociación colombiana de Medicina interna (ACMI) los días 13 y 14 de mayo de 2022.
Resultados: La elevación persistente de TSH, en pacientes que reciben suplementación de hormona tiroidea, puede estar presente hasta un 30% de los pacientes que padecen hipotiroidismo. La causa más frecuente es la mala adherencia al tratamiento, seguido de la malabsorción e incremento en la demanda del medicamento. El abordaje diagnóstico debe ser secuencial para encontrar la causa, en algunos realizando estudios especializados para descartar malabsorción.
Conclusiones: Identificar las causas de hipotiroidismo refractario al tratamiento son clave para tener un adecuado control sintomático y clínico de la patología, y del mismo modo evitar el empleo de dosis supraterapéuticas de levotiroxina, ya que está relacionado con efectos adversos mayores a nivel cardiovascular y óseo.
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- 2023-04-26 (2)
- 2022-12-30 (1)
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