POSSIBILITY OF SHARING L-THYROXINE, DICLOFENAC SODIUM AND CHONDROITIN SULPHATE IN HYPOTHYROIDISM

Nosivets D. S.

CLINICAL AND EXPERIMENTAL MEDICINE

Scentific article

An in-depth study of hypothyroidism of the thyroid gland revealed a combination of this pathology and the development of osteoarthritis of the joints in patients with hypothyroidism. It is known that thyroid hormones affect the metabolism of cartilage and bone tissues and, in case of hypothyroidism, cause the manifestation of degenerative-dystrophic process. Therefore, the appointment of L-thyroxine for basic substitution therapy of hypothyroidism is an indisputable fact, however, the developed osteoarthritis requires the use of a specific group of drugs – NSAIDs, whose effectiveness against the background of the appointment of L-thyroxine has not been widely studied today. It is known that the current standards for the treatment of osteoarthritis (EULAR – European League Against Rheumatism, OARSI – Osteoarthritis Research Society International and ESCEO – The European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases) are recommended for the use SYSADOA, however, the efficacy and safety of their use in the context of substitution therapy with Lthyroxine is insufficiently studied. The author of the article investigated the possibility of sharing L-thyroxine, diclofenac sodium and chondroitin sulfate in hypothyroidism. In order to evaluate the possibility of using drugs, their physical and chemical properties, probable chemical reactions into which they can occur due to the presence of functional groups and pharmacokinetic and pharmacological interactions, which are realized mainly through the influence on biochemical, receptor and functional systems, are considered. Analysis of the chemical properties of L-thyroxine showed that it is a derivative of tyrosine amino acids and is a synthetic analogue of thyroid hormone thyroxine. The combination in one molecule of acid-alkaline properties causes the general ability for all amino acids to exist in the form of bipolar ion. The analysis of the acid-alkaline properties of L-thyroxine has established that its molecule can exist both in non-ionized form and in protonated forms, the equilibrium and the correlation between which is determined by the value of ionization constants. Analysis of the chemical properties of diclofenac sodium in functional groups has shown that it is in its structure a bifunctional compound containing in its structure a secondary amino group and a carboxyl group in the form of its salt with sodium ion. The analysis of the acid-alkaline properties of diclofenac sodium found that its molecule contains an ionized carboxyl group and may exist in two protolithic forms in the aqueous medium. Both forms in the solution are in each other in equilibrium. Analysis of the chemical properties of chondroitin sulfate has shown that it is a polymeric compound, the elemental chain of which is the structure of sulfated glucosamine, and it is possible to distinguish six main groups, which may be chemical reactions and chemical interactions. According to theoretical analysis of the chemical properties of L-thyroxine, diclofenac sodium and chondroitin sulfate, it is possible to assume the possibility of reverse acid-alkaline interactions. The probability of other, strong and irreversible reactions is very low and under normal conditions (temperature, humidity, absence of tough conditions conducive to reaction reactions, and strong alkalis or acids, etc.), the physical mixtures of these compounds are not expected to interact with those that lead to deep destructive changes. It has been established that the properties of active substances when used together in complex pharmacotherapy of hypothyroidism do not provide the conditions under which their profound destructive changes may occur due to the interaction. The joint administration of drugs ensures the development of the unidirectional action of the combination of the active substances of diclofenac sodium and chondroitin sulfate in disorders of cartilage tissue synthesis to restore the structure of the connective tissue and for complex etiological and symptomatic treatment of hypothyroidism. The joint appointment of diclofenac sodium and chondroitin sulfate in the complex therapy of thyroid hypofunction will reduce the dose of NSAIDs, reducing the risk of side effects and toxic effects in case of overdose of diclofenac sodium.

hypothyroidism, osteoarthritis, L-thyroxine, diclofenac sodium, chondroitin sulfate, interaction.

1. Kostina IN. Patologiya schitovidnoy zhelezyi – endogennyiy faktor riska razvitiya osteoartroza visochno-nizhnechelyustnogo sustava. Rossiyskiy stomatologicheskiy zhurnal. 2013;1:34-6. [in Russian].
2. Voloshina LA. Rannya diagnostika gipotireozu, yak faktora progresuvannya osteoartrozu ta komorbidnih protsesiv, osoblivosti fitokorektsiyi. Mezhdunarodnyiy endokrinologicheskiy zhurnal. 2016;7(79):86-92. [in Ukrainian].
3. Nosivets DS, Mamchur VI, Starovoytova NA. Osobennosti farmakoterapii degenerativno-distroficheskih zabolevaniy oporno-dvigatelnogo apparata pri komorbidnyih sostoyaniyah. Mat. XVI Mezhdunar. konf. «Sovremennyie strategiya i taktika v nevrologii». Truskavets: 2014. s. 173-6. [in Russian].
4. Nosivets DS. Patologiya kistkovoyi ta hryaschovoyi tkanin na foni tireoyidnoyi disfunktsiyi. Mat. ХІX Mizhnar. medichnogo kongresu studentiv ta molodih vchenih. Ternopil: Ukrmedkniga; 2015. s. 298. [in Ukrainian].
5. Zagayko AL, Marakushin DI, Kravchenko VM, redkol. Nosivets DS. Korektsiya proyaviv osteoartrozu pri suputnomu gipotireozi. Fiziologichni ta biohimichni mehanizmi rozvitku i korektsiyi patologichnih staniv: materiali mizhvuz. nauk.-prakt. konf. molodih uchenih ta studentiv z mizhnar. uchastyu. Harkiv: Nfau; 2019. s. 37. [in Ukrainian].
6. Nosivets DS. Farmakologichni aspekti vikoristannya nesteroyidnih protizapalnih zasobiv pri osteoartrozi za umov gipotireozu. International scientific and practical conference «Prospects for the development of medicine in EU countries and Ukraine» Wloclawek, Republic of Poland, December 21–22, 2018. Wloclawek: Izdevnieciba «Baltija Publishing», 2018. s. 44-6. [in Ukrainian].
7. Nosivets DS. Vikoristannya NPZZ ta hondroprotektoriv dlya likuvannya osteoartrozu na foni gormonalnoyi disfunktsiyi schitopodibnoyi zalozi. Mizhnar. naukovo-praktichna konf. «Suchasni standarti diagnostiki ta likuvannya zahvoryuvan vnutrishnih organiv». Ivano-Frankivsk, 2019. s. 68-9. [in Ukrainian].
8. Henrotin Y, Mathy M, Sanchez C, Lambert C. Chondroitin sulfate in the treatment of osteoarthritis: from in vitro studies to clinical recommendations. Ther Adv Musculoskelet Dis. 2010 Dec;2(6):335-48.
9. Kubo M, Ando K, Mimura T, Matsusue Y, Mori K. Chondroitin sulfate for the treatment of hip and knee osteoarthritis: current status and future trends. Life Sci. 2009 Sep 23;85(13-14):477-83.
10. Mamchur VI, Nosivets DS. Ratsionalnyiy vyibor hondroprotektorov i effektivnoe primenenie preparata Artedzha pri degenerativnodistroficheskih zabolevaniyah oporno-dvigatelnogo apparata. Bol. Sustavyi. Pozvonochnik. 2018;8(3):38-45. [in Russian].

«Bulletin of problems biology and medicine» Issue 2 Part 1 (150), 2019 year, 172-176 pages, index UDK 615.011

10.29254/2077-4214-2019-2-1-150-172-176