Analiza podataka o učincima levotiroksina na funkcijske testove štitnjače

master's thesis

• Title (english): Analysis of data on the effects of levothyroxine on the determination kof thyroid function tests
• Author: Lucija Daskijević
• Mentor: Anita Somborac Bačura (mentor)
• Committee member: Anita Somborac Bačura (predsjednik povjerenstva)
• Committee member: Marija Grdić Rajković (član povjerenstva)
• Committee member: Domagoj Marijančević (član povjerenstva)
• Granter: University of Zagreb; Faculty of Pharmacy and Biochemistry; (Department of medical biochemistry and haematology); Zagreb
• Defense date and country: 2021-07-01, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Pharmacy; Medical Biochemistry

Abstract

Bolesnici s hipotireozom liječe se levotiroksinom, sintetskim analogom tiroksina. Laboratorij ima središnju ulogu u dijagnozi hipotireoze, praćenju pacijenata i doziranju nadomjesne terapije. Predanalitički čimbenici koji utječu na određivanje koncentracije funkcijskih testova štitnjače su vrijeme uzorkovanja i postupak uzimanja krvi, prehrana, tjelesna aktivnost, stres i dnevni ritam lučenja. Na razine hormona štitnjače utječu i različiti lijekovi poput furosemida, salicilata i heparina te određena stanja kao ona koja su praćena povećanjem koncentracije estrogena, novorođenačka dob i hepatits. Cilj ovog istraživanja bio je ispitati učinke terapije levotiroksinom uzete prije vađenja krvi na koncentracije funkcijskih testova štitnjače kako bi se temeljem dobivenih spoznaja mogao definirati točan postupak pripreme bolesnika. Istraživanje je provedeno prospektivno u KBC Sestre milosrdnice na malom uzorku od 20 dobrovoljaca odrasle životne dobi. Ispitanicima su se uzimali uzorci krvi za određivanje koncentracija TSH, T4, T3, FT4 i FT3 neposredno prije i 2,5 sata nakon uzimanja levotiroksina. Koncentracije TSH, T4, T3, FT4 i FT3 određene su kemiluminiscentnom metodom s mikročesticama na automatskom analizatoru Abbott Architect i2000. Utvrđivanje statistički značajnih razlika u koncentracijama ispitali smo Wilcoxonovim parnim testom. Dobiveni rezultati pokazali su statistički značajan pad koncentracije TSH koji je posljedica njegovog cirkadijalnog ritma lučenja. Terapija levotiroksinom dovela je do statistički značajnog povećanja koncentracije T4 i FT4. S druge strane, terapija levotiroksinom nije izazvala statistički značajnu promjenu koncentracije T3 ni FT3. Terapija levotiroksinom ima klinički značajan učinak na koncentraciju funkcijskih testova štitnjače, preciznije na određivanje T4 i FT4, pa je opravdano od pacijenata zahtijevati da prije vađenja krvi ne uzimaju terapiju, već da to učine nakon uzorkovanja krvi.

Abstract (english)

Levothyroxine, a synthetic thyroxine analog, is used for the treatment of hypothyroidism. The laboratory has a central role in the diagnosis of hypothyroidism, monitoring of patients and dosing of replacement therapy. Preanalytical considerations in thyroid function tests include time and procedure of blood sampling, diet, physical activity, stress and circadian rhythm. Thyroid hormone concentrations are also affected by various medications such as furosemide, salicylates, heparin and certain conditions such as those accompanied by increased estrogen levels, neonatal age and hepatitis. This study aimed to examine the effects of taking levothyroxine therapy before blood sampling to define the exact procedure of patient preparation for thyroid function tests based on the findings. Wilcoxon's paired test was used to determine whether there was a statistically significant difference in concentrations. The study was conducted prospectively in the period from November 2020 to March 2021 in Sestre milosrdnice University Hospital Centre on a small sample of 20 adult volunteers. Blood samples for TSH, T4, T3, FT4 and FT3 assays were obtained immediately before and 2.5 hours after taking levothyroxine. Measurements of TSH, T4, T3, FT4 and FT3 were performed with the chemiluminescence method with microparticles on Abbott Architect i2000 automatic analyzer. Wilcoxon's paired test was used to determine whether there was a statistically significant difference in concentrations. The results of the study showed a statistically significant decrease in TSH concentration due to its circadian rhythm of secretion. Levothyroxine therapy led to a statistically significant increase in T4 and FT4 concentrations. On the other hand, levothyroxine therapy did not cause a statistically significant change in T3 or FT3 concentration. Levothyroxine therapy has a clinically significant effect on thyroid function tests, more specifically on T4 and FT4 concentrations, so it is justified to require patients not to take therapy before blood sampling, but to do so after blood samples are obtained.

• Keywords: hipotireoza; levotiroksin; predanalitika; štitnjača
• Keywords (english): hypothyroidism; levothyroxine; pre-analytics; thyroid gland
• Language: croatian
• URN:NBN: urn:nbn:hr:163:790769
• Study programme: Title: Medical biochemistry; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: magistar/magistra medicinske biokemije i laboratorijske medicine (magistar/magistra medicinske biokemije i laboratorijske medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2022-02-07 11:33:09