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Substitution von Schilddrüsenhormonen

Substitution of thyroid hormones

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Zusammenfassung

Die Indikation zur Substitution mit Levothyroxin ist bei manifester Hypothyreose immer gegeben, bei subklinischer Hypothyreose abhängig von der klinischen Symptomatik. Der entscheidende Kontrollparameter für eine ausreichende Substitution ist bei primärer Hypothyreose das basale TSH, das im unteren Normbereich liegen sollte, bei sekundärer Hypothyreose hingegen das FT4, das im oberen Normbereich eingestellt werden sollte. Man geht davon aus, dass das stoffwechselinaktive Prohormon Levothyroxin in den einzelnen Organen in ausreichender Menge zum stoffwechselaktiven Trijodthyronin umgewandelt wird. Daher ist die Substitution einer Kombination aus Levothyroxin und Liothyronin nicht erforderlich. Zu beachten ist, dass die Resorption von Levothyroxin durch verschiedene Medikamente, insbesondere Säureblocker gestört ist, ebenso bei atrophischer Gastritis oder Malabsorption. Die übliche Substitutionsdosis beträgt 1,5 µg/kgKG, ist unter den genannten Umständen ebenso wie im Kindesalter und in der Schwangerschaft aber erhöht. Im Alter liegt sie dagegen eher niedriger. Die Bioverfügbarkeit unterschiedlicher Levothyroxinpräparate ist nicht identisch, sondern kann um den Faktor 0,8–1,25 schwanken, sodass nach jedem Präparatwechsel die Schilddrüsenfunktion überprüft werden muss.

Abstract

In patients with overt hypothyroidism the substitution with Levothyroxine is mandatory, whereas in patients with subclinical hypothyroidism it is dependent on further clinical signs and symptoms. The main parameter indicating sufficient substitution of Levothyroxine in patients with primary hypothyroidism is TSH, whereas in secondary hypothyroidism it is free T4. At present Levothyroxine is the preparation of choice to restore euthyroidism in hypothyroid patients because it is assumed that the peripheral conversion from T4 to T3 provides the exact amount of T3 needed by every organ. Intestinal absorption of Levothyroxin is around 80%, but only in acid environment and is significantly decreased by proton-pump inhibitors, antacids, atrophic gastritis and Helicobacter pylori infection. The usual required dosage of Levothyroxine is 1.5 µg/kg of body weight but is increased under these conditions as well as during early childhood and pregnancy, and is decreased in older people. The bioavailability of different Levothyroxin generics might change between 0.8 and 1.25. Therefore, the thyroid function of patients, receiving another brand of Levothyroxine has to be re-checked.

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  1. Medizinische Klinik Innenstadt, Universität München, Ziemssenstraße 1, 80336, München, Deutschland

    R. Gärtner & M. Reincke

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  1. R. Gärtner
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  2. M. Reincke
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Correspondence to R. Gärtner.

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Gärtner, R., Reincke, M. Substitution von Schilddrüsenhormonen. Internist 49, 538–544 (2008). https://doi.org/10.1007/s00108-008-2109-9

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