Pharmacotherapy of autoimmune
thyroid disease (AITD) is complex. Apart from the replacement
hormone therapy,
antithyroid agents, beta
adrenoceptor blockers and other drugs, in regard to the present symptoms, it also includes the administration of
glucocorticoids and
immunosuppressive agents. Physiological actions of
glucocorticoids are significant in number, well known and described in details. The most prominent pharmacological properties of
glucocorticoids, that are important fortheir clinical use, are antiinflammatory and immunosuppressive actions. In this article, the most notable clinical pharmacology aspects of
glucocorticoids have been presented, including the basic principles of their
therapeutic use, as well as the most important indications with the examples of dosing regiments (rheumatic disorders, renal diseases,
allergic reactions,
bronchial asthma, gastrointestinal inflammatory diseases,
thrombocytopenia,
organ transplantation, and
Graves' ophthalmopathy). In addition, adverse and toxic effects of
glucocorticoids as well as their interactions with other drugs have been described.
Immunosuppressive agents have important role in treatment of
immune disorders, including the reduction of immune response in
autoimmune diseases and
organ transplantation. Apart from
glucocorticoids,
immunosuppressive agents consist of
calcineurin inhibitors (
cyclosporine,
tacrolimus), antiproliferative and antimetabolic agents (
sirolimus,
azathioprine,
mycophenolate mofetil,
methotrexate,
cyclophosphamide),
monoclonal antibodies: anti-CD3 antibody (muromonab-CD3), anti-CD25 antibody (
daclizumab), anti-
TNF-alpha antibody (
infliximab). In this part, the most updated facts about mechanism of action, rational
therapeutic use, as well as adverse and toxic effects of
immunosuppressive agents have been reviewed.