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  • 1 Szent János Kórház és Észak-budai Egyesített Kórházai Budai Gyermekkórház részleg Budapest Bolyai u. 5–9. 1023
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Bevezetés: Igazolt hypothyreosisban a hormonpótlás általánosan l-tiroxinnal történik. Az utóbbi években egyre több közlemény veti fel az l-trijód-tironin-kiegészítés esetenkénti szükségességét szerzett hypothyreosisban. Cél: Kombinált l-tiroxin- és l-trijód-tironin-kezelés szerepének tanulmányozása hypothyreosis congenitalis formájának egyes eseteiben. Módszer: A szerzők 16 beteg (életkor: 11,9±6,3 év) adatait dolgozták fel, akiknél a referenciatartomány felső határa körüli vagy azt meghaladó szérumszabadtiroxin-szintek (21,16±2,5 pmol/l) ellenére tartósan magas szérum-TSH-értéket találtak (15,7±5,7 mIU/l) és ezért napi egyszeri l-trijód-tironin- (0,18±0,09 μg/kg) kiegészítést kaptak. Eredmények: A két hormon együttes adása a paraméterek gyors javulását okozta (TSH: 4,2±3,15 mIU/l, szabad tiroxin: 16,55±2,4, trijód-tironin: 7,4±1,8 pmol/l). Az eredményesség 10, tartósan kezelt beteg (kezelési időtartam: 2,9±2,0 év) esetében még kifejezettebb volt (TSH: 4,33±3,2 mIU/l, szabad tiroxin: 16,85±3,1, trijód-tironin: 6,4±0,85 pmol/l). Napi l-tiroxin-adagjuk 2,6±0,9 μg/kg-ról 2,18±0,6 μg/kg-ra csökkent, a két hormon aránya 5:1 és 19:1 között volt, szabad frakcióik hányadosa pedig 3,8±0,4-ről 2,6±0,3-re normalizálódott az l-trijód-tironin-kezelés alatt. Következtetések: A szerzők megfigyelése szerint újszülöttkortól hormonpótlásra szoruló hypothyreoticus gyermekekben előfordul (>5%), hogy éveken át működő feed-back mechanizmusuk súlyos zavara alakul ki, ami magas tiroxinszint mellett sem szupprimálódó, fokozott TSH-elválasztásban nyilvánul meg. A bemutatott betegek hormonparaméterei a kombinált kezelés hatására javultak, majd rendeződtek. A szerzők adatai azok felfogását támogatják, akik szerint hypothyreosis egyes eseteiben szükség lehet az l-tiroxin-pótlás kiegészítésére l-trijód-tironinnal. Orv. Hetil., 2013, 154, 738–744.

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