{"id":542,"date":"2019-08-30T13:27:19","date_gmt":"2019-08-30T12:27:19","guid":{"rendered":"http:\/\/blogs.bellvitgehospital.cat\/farmacologiaclinica\/?p=542"},"modified":"2019-08-30T13:33:09","modified_gmt":"2019-08-30T12:33:09","slug":"farmacs-i-tiroide","status":"publish","type":"post","link":"http:\/\/blogs.bellvitgehospital.cat\/farmacologiaclinica\/farmacs-i-tiroide\/","title":{"rendered":"F\u00e0rmacs i tiroide"},"content":{"rendered":"<p><img loading=\"lazy\" class=\"alignnone size-medium wp-image-543 alignleft\" src=\"http:\/\/blogs.bellvitgehospital.cat\/farmacologiaclinica\/wp-content\/uploads\/sites\/5\/2019\/08\/tiroides-300x168.jpg\" alt=\"\" width=\"300\" height=\"168\" \/>La llista de medicaments que afecten la funci\u00f3 tiro\u00efdal augmenta. Des de l\u2019alteraci\u00f3 dels valors de laboratori fins a alteracions funcionals greus. En molts casos es tracta de productes que es prescriuen sense recepta, per\u00f2 tamb\u00e9 es poden produir alteracions tiro\u00efdals amb f\u00e0rmacs antiar\u00edtmics, antineopl\u00e0stics, hipoglucemiants, anticossos monoclonals, antiretrovirals, corticoides, etc. Els mecanismes s\u00f3n diversos. En citem alguns exemples:<\/p>\n<ul>\n<li>alteren el control de l\u2019eix hipot\u00e0lem-hipofisari, (Ipilimumab, dexametasona, metformina, octre\u00f2tida, etc&#8230;)<\/li>\n<li>disminueixen la producci\u00f3 o alliberaci\u00f3 d\u2019hormones tiro\u00efdals (contrasts iodats, liti, amiodarona)<\/li>\n<li>augmenten la producci\u00f3 d\u2019hormones tiro\u00efdals (amiodarona, contrasts iodats)<\/li>\n<li>indueixen o agreugen processos autoimmunes (alemtuzumab, antiretrovirals)<\/li>\n<li>indueixen tiro\u00efditis (nivolumab, sunitinib, IFN-alfa)<\/li>\n<li>alteren la uni\u00f3 a prote\u00efnes plasm\u00e0tiques (raloxif\u00e8n, estr\u00f2gens, 5-FU)<\/li>\n<li>disminueixen el pas de T4 a T3 (amiodarona, dexametasona, propanolol)<\/li>\n<li>alteren el metabolisme o l\u2019eliminaci\u00f3 (sorafenib, carbamacepina, fenobarbital, colestiramina)<\/li>\n<li>disminueixen l\u2019absorci\u00f3 (sucralfat, colestiramina, hidr\u00f2xid d&#8217;alumini, carbonat de calci, sulfat de ferro)<\/li>\n<\/ul>\n<p><img loading=\"lazy\" class=\"size-medium wp-image-544 alignleft\" style=\"text-align: right;font-size: 12px\" src=\"http:\/\/blogs.bellvitgehospital.cat\/farmacologiaclinica\/wp-content\/uploads\/sites\/5\/2019\/08\/NEJM-300x80.png\" alt=\"\" width=\"300\" height=\"80\" srcset=\"http:\/\/blogs.bellvitgehospital.cat\/farmacologiaclinica\/wp-content\/uploads\/sites\/5\/2019\/08\/NEJM-300x80.png 300w, http:\/\/blogs.bellvitgehospital.cat\/farmacologiaclinica\/wp-content\/uploads\/sites\/5\/2019\/08\/NEJM.png 434w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/>Aquesta <a href=\"https:\/\/www.nejm.org\/doi\/full\/10.1056\/NEJMra1901214\">revisi\u00f3<\/a> recent publicada al New England Journal of Medicine ens recorda\u00a0 \u00a0 els\u00a0diferents mecanismes etiopatog\u00e8nics, els f\u00e0rmacs implicats i altres factors contributius. Prendre consci\u00e8ncia d\u2019aquests riscos i de les interaccions potencials permet als metges vigilar-ne els pacients, intervenir-hi quan correspongui i tamb\u00e9 evitar proves innecess\u00e0ries i tractament.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>La llista de medicaments que afecten la funci\u00f3 tiro\u00efdal augmenta. Des de l\u2019alteraci\u00f3 dels valors de laboratori fins a alteracions funcionals greus. En molts casos es tracta de productes que es prescriuen sense recepta, per\u00f2 tamb\u00e9 es poden produir alteracions &hellip; <a href=\"http:\/\/blogs.bellvitgehospital.cat\/farmacologiaclinica\/farmacs-i-tiroide\/\">Continua llegint <span class=\"meta-nav\">&rarr;<\/span><\/a><\/p>\n","protected":false},"author":16,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[19],"tags":[365,414,418,416,408,410,406,412],"_links":{"self":[{"href":"http:\/\/blogs.bellvitgehospital.cat\/farmacologiaclinica\/wp-json\/wp\/v2\/posts\/542"}],"collection":[{"href":"http:\/\/blogs.bellvitgehospital.cat\/farmacologiaclinica\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/blogs.bellvitgehospital.cat\/farmacologiaclinica\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/blogs.bellvitgehospital.cat\/farmacologiaclinica\/wp-json\/wp\/v2\/users\/16"}],"replies":[{"embeddable":true,"href":"http:\/\/blogs.bellvitgehospital.cat\/farmacologiaclinica\/wp-json\/wp\/v2\/comments?post=542"}],"version-history":[{"count":2,"href":"http:\/\/blogs.bellvitgehospital.cat\/farmacologiaclinica\/wp-json\/wp\/v2\/posts\/542\/revisions"}],"predecessor-version":[{"id":548,"href":"http:\/\/blogs.bellvitgehospital.cat\/farmacologiaclinica\/wp-json\/wp\/v2\/posts\/542\/revisions\/548"}],"wp:attachment":[{"href":"http:\/\/blogs.bellvitgehospital.cat\/farmacologiaclinica\/wp-json\/wp\/v2\/media?parent=542"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/blogs.bellvitgehospital.cat\/farmacologiaclinica\/wp-json\/wp\/v2\/categories?post=542"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/blogs.bellvitgehospital.cat\/farmacologiaclinica\/wp-json\/wp\/v2\/tags?post=542"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}