バセドウ病の薬物療法
バセドウ病の薬物療法で最も用いられている抗甲状腺薬は，甲状腺ホルモン産生を十分抑制するが，投与患者の10％以上で副作用が出現する。そのため，投与開始時には副作用の可能性を必ず説明し，特に最初の２カ月は重症副作用を見逃さないように注意する。ここでは，本薬剤の選択と一般的な投与法，妊娠中（予定）の患者への配慮，治療法を変えるタイミング，抗甲状腺薬以外の治療に，焦点を当てていく。...
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| Published in | 日本内分泌・甲状腺外科学会雑誌 Vol. 35; no. 3; pp. 152 - 155 |
|---|---|
| Main Author | |
| Format | Journal Article |
| Language | Japanese |
| Published |
日本内分泌外科学会・日本甲状腺外科学会
2018
|
| Subjects | |
| Online Access | Get full text |
| ISSN | 2186-9545 |
| DOI | 10.11226/jaesjsts.35.3_152 |
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| Abstract | バセドウ病の薬物療法で最も用いられている抗甲状腺薬は，甲状腺ホルモン産生を十分抑制するが，投与患者の10％以上で副作用が出現する。そのため，投与開始時には副作用の可能性を必ず説明し，特に最初の２カ月は重症副作用を見逃さないように注意する。ここでは，本薬剤の選択と一般的な投与法，妊娠中（予定）の患者への配慮，治療法を変えるタイミング，抗甲状腺薬以外の治療に，焦点を当てていく。 |
|---|---|
| AbstractList | バセドウ病の薬物療法で最も用いられている抗甲状腺薬は，甲状腺ホルモン産生を十分抑制するが，投与患者の10％以上で副作用が出現する。そのため，投与開始時には副作用の可能性を必ず説明し，特に最初の２カ月は重症副作用を見逃さないように注意する。ここでは，本薬剤の選択と一般的な投与法，妊娠中（予定）の患者への配慮，治療法を変えるタイミング，抗甲状腺薬以外の治療に，焦点を当てていく。 |
| Author | 西原, 永潤 |
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| Copyright | 2018 日本内分泌外科学会・日本甲状腺外科学会 |
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| References | 6. Watanabe N, Narimatsu H, Noh JY, et al.: Antithyroid drug-induced hematopoietic damage: a retrospective cohort study of agranulocytosis and pancytopenia involving 50,385 patients with Gravesʼ disease. J Clin Endocrinol Metab 97: 49-53, 2012 8. Sato S, Noh JY, Sato S, et al.: Comparison of efficacy and adverse effects between methimazole 15 mg+inorganic iodine 38 mg/day and methimazole 30 mg/day as initial therapy for Gravesʼ disease patients with moderate to severe hyperthyroidism. Thyroid 25: 43-50, 2015 12. Kim YA, Cho SW, Choi HS, et al.: The Second Antithyroid Drug Treatment Is Effective in Relapsed Gravesʼ Disease Patients:A Median 11-Year Follow-Up Study. Thyroid 27: 491-496, 2017 14. Mohlin E, Filipsson Nystrom H, et al.: Long-term prognosis after medical treatment of Gravesʼ disease in a northern Swedish population 2000-2010. Eur J Endocrinol 170: 419-427, 2014 4. Kubota S, Amino N, Matsumoto Y, et al.: Serial changes in liver function tests in patients with thyrotoxicosis induced by Gravesʼ disease and painless thyroiditis. Thyroid 18: 283-287, 2008 1. Cooper DS: In:Braverman LE and Cooper DS (eds), Werner & Ingberʼs The Thyroid 10th edition LWW, Philadelphia, 2013, p492-516. 11. Kobayashi S, Noh JY, Mukasa K, et al.: Characteristics of agranulocytosis as an adverse effect of antithyroid drugs in the second or later course of treatment. Thyroid 24: 796-801, 2014 3. 西原永潤：今日の治療指針2018年版 甲状腺機能亢進症（甲状腺クリーゼを含む） 医学書院，東京，2018，p754-756 9. Nakamura H, Noh JY, Itoh K, et al.: Comparison of methimazole and propylthiouracil in patients with hyperthyroidism caused by Gravesʼ disease. J Clin Endocrinol Metab 92: 2157-2162, 2007 10. Takata K, Amino N, Kubota S, et al.: Benefit of short-term iodide supplementation to antithyroid drug treatment of thyrotoxicosis due to Gravesʼ disease. Clin Endocrinol (Oxf) 72: 845-850, 2010 7. Takata K, Kubota S, Fukata S, et al.: Methimazole-induced agranulocytosis in patients with Gravesʼ disease is more frequent with an initial dose of 30 mg daily than with 15 mg daily. Thyroid 19: 559-563, 2009 2. 日本甲状腺学会編：バセドウ病治療ガイドライン2011 南江堂，東京，2011，p24-30 5. Tajiri J, Noguchi S, Murakami T, et al.: Antithyroid drug-induced agranulocytosis. The usefulness of routine white blood cell count monitoring. Arch Intern Med 150: 621-624, 1990 13. Ross DS, Burch HB, Cooper DS, et al.: 2016 American thyroid association guidelines for giagnosis and management of hyperthyroidism and other causes of thyrotoxicosis. Thyroid 26: 1343-1421, 2016 |
| References_xml | – reference: 2. 日本甲状腺学会編：バセドウ病治療ガイドライン2011 南江堂，東京，2011，p24-30． – reference: 3. 西原永潤：今日の治療指針2018年版 甲状腺機能亢進症（甲状腺クリーゼを含む） 医学書院，東京，2018，p754-756． – reference: 13. Ross DS, Burch HB, Cooper DS, et al.: 2016 American thyroid association guidelines for giagnosis and management of hyperthyroidism and other causes of thyrotoxicosis. Thyroid 26: 1343-1421, 2016 – reference: 8. Sato S, Noh JY, Sato S, et al.: Comparison of efficacy and adverse effects between methimazole 15 mg+inorganic iodine 38 mg/day and methimazole 30 mg/day as initial therapy for Gravesʼ disease patients with moderate to severe hyperthyroidism. Thyroid 25: 43-50, 2015 – reference: 6. Watanabe N, Narimatsu H, Noh JY, et al.: Antithyroid drug-induced hematopoietic damage: a retrospective cohort study of agranulocytosis and pancytopenia involving 50,385 patients with Gravesʼ disease. J Clin Endocrinol Metab 97: 49-53, 2012 – reference: 12. Kim YA, Cho SW, Choi HS, et al.: The Second Antithyroid Drug Treatment Is Effective in Relapsed Gravesʼ Disease Patients:A Median 11-Year Follow-Up Study. Thyroid 27: 491-496, 2017 – reference: 10. Takata K, Amino N, Kubota S, et al.: Benefit of short-term iodide supplementation to antithyroid drug treatment of thyrotoxicosis due to Gravesʼ disease. Clin Endocrinol (Oxf) 72: 845-850, 2010 – reference: 14. Mohlin E, Filipsson Nystrom H, et al.: Long-term prognosis after medical treatment of Gravesʼ disease in a northern Swedish population 2000-2010. Eur J Endocrinol 170: 419-427, 2014 – reference: 7. Takata K, Kubota S, Fukata S, et al.: Methimazole-induced agranulocytosis in patients with Gravesʼ disease is more frequent with an initial dose of 30 mg daily than with 15 mg daily. Thyroid 19: 559-563, 2009 – reference: 11. Kobayashi S, Noh JY, Mukasa K, et al.: Characteristics of agranulocytosis as an adverse effect of antithyroid drugs in the second or later course of treatment. Thyroid 24: 796-801, 2014 – reference: 1. Cooper DS: In:Braverman LE and Cooper DS (eds), Werner & Ingberʼs The Thyroid 10th edition LWW, Philadelphia, 2013, p492-516. – reference: 5. Tajiri J, Noguchi S, Murakami T, et al.: Antithyroid drug-induced agranulocytosis. The usefulness of routine white blood cell count monitoring. Arch Intern Med 150: 621-624, 1990 – reference: 9. Nakamura H, Noh JY, Itoh K, et al.: Comparison of methimazole and propylthiouracil in patients with hyperthyroidism caused by Gravesʼ disease. J Clin Endocrinol Metab 92: 2157-2162, 2007 – reference: 4. Kubota S, Amino N, Matsumoto Y, et al.: Serial changes in liver function tests in patients with thyrotoxicosis induced by Gravesʼ disease and painless thyroiditis. Thyroid 18: 283-287, 2008 |
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| SubjectTerms | バセドウ病寛解と再燃 副作用 妊娠 抗甲状腺薬 根治療法 |
| Title | バセドウ病の薬物療法 |
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