在精神病学实践中使用锂药物对甲状腺状态的影响

Egor E. Nikolaev, A. Golenkov, I. Madyanov
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引用次数: 0

摘要

锂具有广泛的有益药理作用,实际上是双相情感障碍患者的单一选择药物。同时,锂会引起甲状腺结构和功能的变化。甲状腺功能减退和甲状腺肿是接受长期锂治疗的患者中最常见的甲状腺疾病。因此,精神科医生可能会怀疑对甲状腺病变患者使用锂的安全性。当患者被发现有锂引起的甲状腺疾病时,可能会出现额外的困难。在国内的精神病学手册中,这一主题没有得到充分的涵盖。这就是为什么本文的目的是回顾关于锂对甲状腺影响的现代文献来源,监测锂引起的甲状腺疾病的建议以及纠正发展中的病理的方法。本文讨论了锂治疗期间甲状腺结构和功能紊乱的可能机制。关于性别、种族和锂治疗持续时间对甲状腺病理发展的影响的文献资料被提出。本文介绍了甲状腺病理方面锂药物安全使用的算法。如果在初次检查时甲状腺功能略有下降,必要时可开锂,但甲状腺功能减退应用左甲状腺素钠治疗。在存在难以纠正的甲状腺功能减退时,建议选择另一种情绪稳定剂。锂制剂是双相情感障碍复杂治疗中最重要的组成部分。由于发展甲状腺病理,这是很好地纠正了药物和更多的往往是短暂的特征,是不合理的拒绝治疗。为了保证锂离子治疗的安全性,在治疗前和治疗中及时监测甲状腺的主要参数是很重要的。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
THE USE OF LITHIUM MEDICATIONS IN PSYCHIATRIC PRACTICE IN THE CONTEXT OF THEIR EFFECT ON THE THYROID STATUS
Lithium has a wide range of beneficial pharmacological effects and is practically a single option drug in some patients with bipolar affective disorder. At the same time, lithium can cause changes in the structure and function of the thyroid gland. Hypothyroidism and goiter are the most common thyroid disorders in patients receiving long-term lithium therapy. Hence, psychiatrists may have doubts about the safety of administering lithium to patients with thyroid pathology. Additional difficulties may arise when a patient is found to have lithium-induced thyroid disorders. This topic is not sufficiently covered in domestic manuals on psychiatry. That is why the purpose of this article is to review modern literature sources on the effect of lithium on the thyroid gland, recommendations for monitoring lithium-induced thyroid disorders and ways to correct the developing pathology. The article discusses possible mechanisms of disorders in the structure and functioning of the thyroid gland during lithium treatment. Literature data on the influence of gender, ethnicity and duration of lithium therapy on the development of thyroid pathology are presented. The article presents the algorithm for the safe use of lithium medications in the aspect of thyroid pathology. If the thyroid function is slightly reduced during the initial examination, lithium can be prescribed if necessary, but hypothyroidism should be treated with sodium levothyroxine. In the presence of difficult-to-correct hypothyroidism, it is recommended to choose another mood stabilizing agent. Lithium preparations are the most important component in the complex treatment of bipolar affective disorder. Withholding therapy due to the developed thyroid pathology, which is well corrected with medications and more often has a transient character, is not justified. For safe lithium treatment, it is important to monitor the main parameters of the thyroid gland in a timely manner before and during therapy.
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