Gerber H, Noth D
Chemisches Zentrallabor, Inselspital, Bern.
Ther Umsch. 1999 Jul;56(7):374-9. doi: 10.1024/0040-5930.56.7.374.
Pathogenesis, diagnostic procedures and therapy of amiodarone-induced thyrotoxicosis (AIT) and hypothyroidism (AIH) are briefly discussed. Diagnosis of AIT and AIT is based on the classical signs and symptoms of thyroid dysfunction, although oligosymptomatic cases may occur, and on laboratory tests such as TSH, fT4 und fT3. In AIT, radioiodine therapy usually is no option due to the high iodine content of amiodarone. Besides withdrawal of amiodarone, medical and surgical treatment remain the only modalities. If arrhythmia can be controlled by an alternative treatment, amiodarone should be discontinued although this will not immediately restore normal thyroid function. For medical treatment, thionamides, perchlorate (not available in Switzerland), steroids (mainly for type II and mixed forms of AIT) and lithium (only for severe cases) are available. Surgery is a valid therapeutical option for severe forms of AIT which cannot be controlled adequately by medical treatment. The main advantage of surgical therapy of AIT is the rapid correction of thyrotoxicosis combined with the possibility to continue amiodarone, if it is necessary and effective. With AIH, amiodarone does not have to be stopped, if indicated and effective, and L-thyroxine is the therapy of choice.
本文简要讨论了胺碘酮所致甲状腺毒症（AIT）和甲状腺功能减退（AIH）的发病机制、诊断方法及治疗。AIT和AIH的诊断基于甲状腺功能障碍的典型体征和症状，尽管可能存在症状不明显的病例，同时也依赖于促甲状腺激素（TSH）、游离甲状腺素（fT4）和游离三碘甲状腺原氨酸（fT3）等实验室检查。在AIT中，由于胺碘酮含碘量高，通常不选择放射性碘治疗。除停用胺碘酮外，药物和手术治疗仍是仅有的治疗方式。如果心律失常能够通过替代治疗得到控制，尽管停用胺碘酮不会立即恢复甲状腺功能正常，但仍应停用。药物治疗方面，可使用硫代酰胺、高氯酸盐（瑞士无此药）、类固醇（主要用于II型和混合型AIT）以及锂盐（仅用于严重病例）。对于药物治疗无法充分控制的严重AIT，手术是一种有效的治疗选择。AIT手术治疗的主要优点是能迅速纠正甲状腺毒症，且如有必要且有效，可继续使用胺碘酮。对于AIH，如果有指征且有效，不必停用胺碘酮，左甲状腺素是首选治疗药物。
