Interferências na absorção de levotiroxina e dificuldades no manuseio de pacientes com hipotireoidismo na unidade de terapia intensiva: relato de dois casos e revisão de literatura

Souza, Marcus Vinícius Leitão de

doi:10.1590/s0103-507x2011000200019

Cited by 4 publications

(2 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Em relação à levotiroxina, as formulações enterais à base de soja e com presença de fibras podem aumentar a excreção fecal do fármaco (Vinagre & Souza, 2011;Barbosa et al, 2018). Dessa forma, medidas preventivas para evitar essa ocorrência envolve evitar formulações à base de soja, monitorar a função tireoidiana do paciente, eventualmente aumentar a dose do fármaco e/ou suspender por pelo menos duas horas a TNE para realizar a administração do fármaco (Vinagre & Souza, 2011). Alguns estudos demonstram que a recomendação de pausa da dieta ainda não está difundida de tal forma que faça parte da rotina de cuidado ao paciente (Barbosa et al, 2018).…”

Section: Metodologiaunclassified

Pacientes sob terapia nutricional enteral e prevalência de interações fármaco-nutrientes no ambiente hospitalar

Kampa

Reis

Mezzomo

et al. 2020

RSD

View full text Add to dashboard Cite

1 Pacientes sob terapia nutricional enteral e prevalência de interações fármaco-nutrientes no ambiente hospitalar Patients under enteral nutritional therapy and prevalence of drug-nutrient interactions in the hospital environment Pacientes bajo terapia nutricional enteral y interacciones entre medicamentos y nutrientes en el entorno hospitalario Resumo Determinar a prevalência das possíveis interações fármaco-nutrientes em pacientes hospitalizados submetidos à terapia nutricional enteral e analisar o risco clínico. Estudo observacional, analítico e retrospectivo com prontuários de 104 pacientes em terapia nutricional enteral, internados em um hospital universitário em uma capital do sul do Brasil. Foram coletadas informações no prontuário eletrônico Tasy®, dos pacientes internados no período de julho a dezembro de 2018, que receberam terapia nutricional enteral. Os fármacos utilizados foram classificados conforme o Anatomical Therapeutic Chemical Code. As interações Research, Society and Development, v. 9, n. 3, e162932680, 2020 (CC BY 4.0) | ISSN 2525-3409 | DOI: http://dx.doi.org/10.33448/rsd-v9i3.2680 2 fármaco-nutrientes foram determinadas pelo programa Micromedex 2.0®. Dos 112medicamentos utilizados pelos pacientes, observou-se 28,6% de potencial prevalência de interações fármaco-nutrientes, sendo 6,25% de potencial de interação fármaco com alimentos em geral e 2,7% de potencial de interação com a terapia nutricional enteral, de gravidade moderada (n = 19; 59,4%), com bom nível de evidência (n = 17; 53,2%) e de início imediato (n = 22; 68,7%). Os fármacos envolvidos foram, principalmente, a fenitoína, levotiroxina e varfarina. Os pacientes em terapia nutricional enteral apresentam pequeno mas prejudicial risco de interações fármaco-nutrientes, principalmente relacionados ao tratamento de crises convulsivas, à tireoide, e à coagulação sanguínea. Sugere-se que protocolos sejam implementados a fim de garantir segurança nutricional e medicamentosa aos pacientes hospitalizados. Palavras-chave:Nutrição enteral; Interações fármaco-nutrientes; Terapia nutricional; Efeitos colaterais e reações adversas relacionados a medicamentos. Abstract To determine the prevalence of possible drug-nutrient interactions in hospitalized patients undergoing enteral nutritional therapy and to analyze the clinical risk. Observational, analytical and retrospective study with medical records of 104 patients undergoing enteral nutritional therapy, admitted to a university hospital in a capital of southern Brazil. Information was collected in the electronic medical record Tasy®, from patients hospitalized from July to December 2018, who received enteral nutritional therapy. The drugs used were classified according to the Anatomical Therapeutic Chemical Code. Drug-nutrient interactions were determined using the Micromedex 2.0® program. Of the 112 medications used by patients,28.6% of potential prevalence of drug-nutrient interactions was observed, with 6.25% of potential for drug interaction with food in general and 2.7% of potential for in...

show abstract

Section: Metodologiaunclassified

Pacientes sob terapia nutricional enteral e prevalência de interações fármaco-nutrientes no ambiente hospitalar

Kampa

Reis

Mezzomo

et al. 2020

RSD

View full text Add to dashboard Cite

show abstract

“…There are various treatments for hypothyroidism, one of the most common ones being the synthetic hormone levothyroxine (LT 4 ), which can be used in combination with triiodothyronine or alone [15]. This paper reports on the dermatological changes observed in a case of canine hypothyroidism before and after the use of levothyroxine, highlighting the effectiveness of using solely this synthetic hormone in low doses.…”

Section: Introductionmentioning

confidence: 99%

Epidermal Renewal after Treatment of Primary Canine Hypothyroidism using Levothyroxine

Alves

Waller

Costa

et al. 2021

Acta Scientiae. Vet.

View full text Add to dashboard Cite

Background: Primary canine hypothyroidism, an endocrine disorder that causes imbalances in the hypothalamus-pituitarythyroid axis, is a common cause of endocrine dermatoses, which frequently presents with opaque dry brittle hair. Tissue changes are also visible, such as myxedema, hyperkeratosis, epidermal atrophy, alopecia, and others. This paper describes the skin changes caused by primary hypothyroidism in a female dog before and after treatment with levothyroxine.Case: This case study involved a 7-year-old Dalmatian bitch with a history of weight gain and changes such as rough dry brittle hair. For about a year, the dog also had also presented symmetrical erythematous and alopecia skin lesions in the regions of the hind limbs, lower back and tail, progressive lethargy and fatigue after exercise. A hemogram showed mild normocytic and normochromic regenerative anemia, as well as mild leukopenia and neutropenia. Biochemical tests revealed increased levels of creatinine, total cholesterol, and triglycerides. Skin biopsy revealed the presence of comedones in the epidermis and acanthosis and trichilemmal keratinization. Hormonal tests revealed high TSH and low free T4 and total T4 levels. A cervical ultrasound scan showed changes in the thyroid glands, with hypoechoic parenchyma, in addition to increased size of the right lobe, suggesting thyroiditis. Based on these exams, the patient was diagnosed with primary hypothyroidism, and treatment with levothyroxine was instituted.Discussion: Around 90% of dogs with hypothyroidism show a decrease in total T4 and about 65-75% of them show an increase in TSH levels. In endocrinopathy, there is a decrease in the expression of T3 receptors in the keratinocytes and genes responsible for epidermal renewal. Also, molecules that affect epidermal differentiation bind to intracellular receptors belonging to the steroid/thyroid hormone superfamily. In this study, however, the application of the minimum levothyroxine dose restored the normal epidermal pattern for the species and the remaining parameters returned to normal. The hormone T3 acts in the differentiation of keratinocytes, a fact that, although not yet proven, is believed to be indirect and mediated by the epidermal growth factor or by the expression of the genes responsible for the renewal of the epidermis. Besides, some effects on the epidermis caused by deficiency of thyroid hormones may be due to secondary vitamin A deficiency, which is necessary for epithelial differentiation and binding epidermal growth factor (EGF) to the cell. Still, there is a theory that sex hormones also affect the differentiation of the epidermis, as studies show that deficiency causes effects similar to those caused by hypothyroidism. Some studies indicate the investigation of the relationship between secondary vitamin D deficiency and the increased cellularity of the epidermis of the spayed hypothyroid female rats. Additionally, the mechanism of the formation of hyperkeratosis in hypothyroidism is not yet elucidated. T3 is known to regulate keratingene expression and perhaps also epidermal maturation, epithelial cycle, and normal keratin synthesis. The single treatment with levothyroxine in the female dog was effective in promoting the restoration of gene expression to T3 in keratinocytes.Keywords: dermatopathies, endocrinopathies, hypothyroidism, levothyroxine, synthetic hormone.

show abstract

The Economic Impact of Levothyroxine Dose Adjustments: the CONTROL HE Study

Ernst¹,

Barr²,

Elmor³

et al. 2016

Clin Drug Investig

View full text Add to dashboard Cite

BackgroundIn general, hypothyroidism can be adequately treated with a consistent daily dose of levothyroxine. However, the need for levothyroxine dose adjustments is frequent in clinical practice. The extent to which levothyroxine dose adjustments increase the utilization of healthcare resources has not previously been described in the clinical literature.ObjectiveThe primary objective of our study was to measure the effect of levothyroxine dose adjustments in terms of their utilization of healthcare resources including direct and indirect costs. A secondary goal was to identify any differences in patient characteristics that may be responsible for levothyroxine dose adjustments.MethodsA retrospective medical chart review was conducted among patients of selected healthcare providers in the USA. Patients who were recently started on levothyroxine therapy (<6 months) were excluded to avoid situations that were more likely attributable to treatment initiation than inadequate therapeutic effect. Trained nurses extracted data from patient charts and electronic medical record systems for review. We analyzed the cost of resources consumed by the frequency of levothyroxine dose changes over 24 months: 0 dose changes (no dose adjustment group); one dose change, two dose changes, three or more dose changes (≥1 dose adjustment group).ResultsThe study included 454 patients. Overall estimated resource utilization was higher per patient in the ≥1 dose adjustment group (US$5824) vs. the no dose adjustment group (US$3166) during the 24-month study period. When direct and indirect costs were combined, overall costs of care were greatest in patients requiring three or more dose adjustments (US$8220/patient). Patients in this cohort incurred 2.5-fold greater total costs compared with patients requiring no dose adjustments (US$8220 vs. US$3166). Among the 58 patients in the group requiring three or more dose adjustments, mean direct medical costs were significantly higher than in the patients requiring no dose adjustments (US$6387 vs. US$2182). Patients with at least one dose adjustment experienced a 40.3% increase in lost productivity vs. patients who had no dose adjustments (US$1381 vs. US$984). Loss of productivity was highest among patients with three or more levothyroxine dose adjustments. Among this cohort, there was an 86.4% increase in lost productivity vs. patients who had no levothyroxine dose adjustments (US$1833 vs. US$984).ConclusionsPatients experiencing multiple levothyroxine dose adjustments were shown to consume more healthcare resources, resulting in higher costs than those who required no dose adjustments. Each care episode contributed to lost time and wages with total estimated lost productivity escalating with increasing levothyroxine dose adjustments over a 24-month period.Electronic supplementary materialThe online version of this article (doi:10.1007/s40261-016-0462-3) contains supplementary material, which is available to authorized users.

show abstract

Interferências na absorção de levotiroxina e dificuldades no manuseio de pacientes com hipotireoidismo na unidade de terapia intensiva: relato de dois casos e revisão de literatura

Cited by 4 publications

References 20 publications

Pacientes sob terapia nutricional enteral e prevalência de interações fármaco-nutrientes no ambiente hospitalar

Pacientes sob terapia nutricional enteral e prevalência de interações fármaco-nutrientes no ambiente hospitalar

Epidermal Renewal after Treatment of Primary Canine Hypothyroidism using Levothyroxine

The Economic Impact of Levothyroxine Dose Adjustments: the CONTROL HE Study

Contact Info

Product

Resources

About