甲状腺功能亢进症的药物应用

治疗甲状腺功能亢进症（甲亢）的药物主要包括抗甲状腺药（ATD）甲巯咪唑（MMI）和丙基硫氧嘧啶（PTU），β受体阻滞剂盐酸普萘洛尔，碘剂复方碘溶液，糖皮质激素泼尼松等，如何合理应用这些药物是临床医生应慎重考虑的问题。笔者认为药物选择的最佳方案要从药物的安全性、剂量、给药方式、激素伍用时机等方面进行综合考虑。通过查阅文献得出，与PTU相比，MMI不良反应显著低于PTU，而且MMI的不良反应大多与剂量有关，而PTU的不良反应与剂量无显著相关性，特别是PTU可能导致致命性肝损害，因此，笔者认为治疗甲亢应首选MMI，尤其对儿童和青少年甲亢患者，而PTU主要应用于孕妇和甲亢危象；盐酸普萘洛尔可按说明书服用；碘剂用于甲状腺术前准备和甲亢危象；糖皮质激素泼尼松在严重甲亢、肝功能损害、白细胞减少、皮肤过敏时可小剂量应用2～8周。

Drug application of hyperthyroidism

Drugs application in hyperthyroidism therapy mainly including following kinds of drugs, MMI and PTU are the common antithyroid drugs using for hyperthyroidism therapy and β receptor blockers usually chooses Propranolol, com- pound iodine solution and glucocorticoid Prednisone are also often used for hyperthyroidism. Doctors should consider care- fully about how to choose these drugs reasonably. Best drug usage plan should consider drug safety, dosage, drug delivery and the time of hormone compatibility. According to literature, compared with PTU, the adverse reaction incidence of MMI is obvious lower than PTU and the adverse reaction of MMI manifests dose relation but PTU has no dose relation. More- over, PTU can lead to fatal liver damage. Therefore, MMI is a preferred choice especially for children and young people. PTU is mainly used for pregnant woman and thyroid crisis. Administration of Propranolol is according to drug manual. Io- dine is used for thyroid preoperative preparation and thyroid crisis. Prednisone should be used for serious thyroid, liver damage, leukopenia and skin allergies with small dosage in 2 to 8 weeks.