Τίτλος – Title
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Δυσλειτουργία του Θυρεοειδούς στη Θεραπευτική Χρήση της Ιντερφερόνης Thyroid Dysfunction during Interferon Treatment |
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Συγγραφέας – Author
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Υβόννη Δημουλά, Μαρία Λυμπέρη, Πλούταρχος Κούρτης Εργαστήριο Φυσιολογίας Σχολών Επιστημών Υγείας, Τεχνολογικό Εκπαιδευτικό Ίδρυμα Αθήνας και Εργαστήριο Πειραματικής Φυσιολογίας Ιατρικής Σχολής Πανεπιστημίου Αθηνών Yvonne Dimoula, Maria Lymberi, Ploutarchos Kourtis Laboratory of Physiology, Department of Health and Caring Professions, Technological Educational Institution of Athens and Laboratory of Physiology, Medical School, University of Athens |
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Παραπομπή – Citation
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Δημουλά,Υ., Λυμπέρη,Μ., Κούρτης,Π. : Δυσλειτουργία του Θυρεοειδούς στη Θεραπευτική Χρήση της Ιντερφερόνης , Επιθεώρηση Κλιν. Φαρμακολ. Φαρμακοκινητ. 16 : 161-171 (1998) Dimoula,Y., Lymberi,M., Kourtis,P. : Thyroid Dysfunction during Interferon Treatment, Epitheorese Klin. Farmakol. Farmakokinet. 16: 161-171 (1998) |
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Ημερομηνία Δημοσιευσης – Publication Date
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27-12-1998
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Γλώσσα Πλήρους Κειμένου –
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Ελληνικά – Greek |
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Λέξεις κλειδιά – Keywords
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Ιντερφερόνη Α, Ιντερφερόνη Β, ηπατίτιδα C, ηπατίτιδα Β, σκλήρυνση κατά πλάκας, δυσλειτουργία θυρεοειδούς, υπερθυρεοειδισμός, υποθυρεοειδισμός, θυρεοειδίτιδα, αντιθυρεοειδικά αντισώματα, αντιμικροσωμιακά αντισώματα, αντιθυρεοσφαιρινικά αντισώματα, αντισώματα έναντι του υποδοχέα της TSH Interferon A, interferon B, viral hepatitis C, viral hepatitis B, multiple sclerosis, thyroid dysfunction, hyperthyroidism, hypothyroidism, thyroiditis, antimicrosomal anti-bodies, antithyroglobulin antibodies, thyrotropin receptor-binding inhibitting immunoglobulin
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Λοιποί Όροι – Other Terms
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Άρθρο Article |
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Περίληψη – Summary
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Τα τελευταία χρόνια η χρήση της ανθρώπινης βιοσυνθετικής ιντερφερόνης έχει πολύ επεκταθεί. Ιντερφερόνη τύπου Ι, κυρίως IFN A, χρησιμοποιείται στη θεραπεία της ηπατίτιδας C και B 1-a καθώς και Β 1-b στη θεραπεία της σκλήρυνσης κατά πλάκας, στη μορφή κατά ώσεις. Η επίπτωση δυσλειτουργίας του θυρεοειδούς σε πάσχοντες από ηπατίτιδα C είναι ηυξημένη και πριν τη λήψη οποιασδήποτε αγωγής. Κατά τη διάρκεια της θεραπείας έχουν τεκμηριωθεί τέσσερες τύποι επίδρασης στο θυρεοειδή: αύξηση των αντιθυρεοειδικών αντισωμάτων, υποθυρεοειδισμός, υπερθυρεοειδισμός και θυρεοειδίτιδα. Η δυσλειτουργία του θυρεοειδούς μπορεί να εμφανισθεί έξ εβδομάδες μέχρι δώδεκα μήνες από την έναρξη της θεραπείας ή να παρατηρηθεί μετά τη διακοπή της. Αφορά κυρίως το θήλυ φύλο, δεν εξαρτάται από τη δόση του φαρμάκου και η πιθανότητα να εμφανισθεί είναι μεγαλύτερη σε ασθενείς που έχουν ήδη θετικά αντιθυρεοειδικά ή άλλα αυτοαντισώματα. Η δυσλειτουργία είναι κατά κανόνα αναστρέψιμη και απαιτεί μόνο προσωρινή θεραπεία στις περισσότερες περιπτώσεις. Οι ακριβείς μηχανισμοί με τους οποίους η ιντερφερόνη προκαλεί τη δυσλειτουργία του θυρεοειδούς είναι ακόμη σκοτεινοί. Μπορεί να οφείλεται στις ανοσοτροποποιητικές δράσεις της ιντερεφερόνης, στην επαγωγή της εκδήλωσης προϋπάρχουσας υποκλινικής θυρεοειδίτιδας ή σε απ’ ευθείας τοξική δράση του φαρμάκου. Τα βιβλιογραφικά δεδομένα είναι πτωχά για την επίδραση της ιντερφερόνης Β 1-a και B 1-b στο θυρεοειδή, όταν αυτή χρησιμοποιείται για τη θεραπεία της σκλήρυνσης κατά πλάκας. Αύξηση ή εμφάνιση για πρώτη φορά αντιθυρεοειδικών αντισωμάτων και σποραδικά περιστατικά υποθυρεοειδισμού, υπερθυρεοειδισμού και θυρεοειδίτιδας με αιχμή εμφάνισης στο πρώτο τρίμηνο θεραπείας, παρουσιάζονται στις υπάρχουσες μελέτες. Τα φαινόμενα είναι κατά κανόνα αναστρέψιμα και σπάνια μόνο απαιτούν διακοπή της αγωγής. Συμπερασματικά λοιπόν μπορεί να λεχθεί ότι έλεγχος της θυρεοειδικής λειτουργίας και των αντιθυρεοειδικών αντισωμάτων πρέπει να γίνεται τόσο πριν την έναρξη όσο και κατά τη διάρκεια της θεραπείας με ιντερφερόνη Α της ηπατίτιδας C και με ιντερφερόνη Β για τη σκλήρυνση κατά πλάκας. During the last years the use of human recombinant interferon has been expanded. Interferon type I, mainly IFN A, has been used in the treatment of chronic hepatitis C (CHC) and Interferon type I mainly IFN B 1-a and IFN B 1-b has been used in the treatment of Multiple Sclerosis, in the relapsing-remitting form. The risk of thyroid dysfunction is increased in patients with hepatitis C before they take any treatment. During the treatment with Interferon, four types of thyroid dysfuncion have been described. Increase of the antithyroid antibodie’s titles, hypothyroidism, hyperthyroidism and thyroiditis. The dysfunction may occur 6 weeks to 12 months after initiation of treatment and it may be observed after several courses of Interferon or after withdrawal of Interferon treatment. Mainly it is found in women, is indipended from the dose of the drug and the risk of thyroid dysfunction is increased in patients that already had antithyroid or other auto-antibodies. There is no correlation between the occurence of thyroid dysfuncion and the efficacy of therapy. Thyroid dysfunction is usually reversible and treatment is temporarily needed in most of the patients. The mechanism of the thyroid dysfunction during Interferon therapy is still unclear. The possible mechanisms could be an auto-immune reaction related to the immunomodulatory properties of Interferon, an exacerbation of a previous latent autoimmune thyroiditis or a direct toxicity of Interferon to the thyroid. There are very few reports associating the thyroid dysfunction to the treatment of Multiple Sclerosis (MS) with Interferon B 1-a and B 1-b. Occurence or increase in the titles of antithyroid antibodies and sporadic cases of hyperthyroidism, hypothyroidism and thyroiditis, usually during the first trimester of treatment, are found in the literature but there is reversibility without withdrawal of the therapy. Conclusively the thyroid function and antithyroid antibodies shoud be checked before and during Interferon therapy in CHC and MS. |
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Αναφορές – References
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