Meurisse M, Gollogly L, Degauque C, Fumal I, Defechereux T, Hamoir E
Department of Endocrine Surgery and Transplantation, Centre Hospitalier Universitaire de Liège, B35, Domaine Universitaire du Sart-Tilman, 4000 Liege, Belgium.
World J Surg. 2000 Nov;24(11):1377-85. doi: 10.1007/s002680010228.
Thyrotoxicosis is the clinical syndrome that results when tissues are exposed to high levels of circulating thyroid hormones. In most instances thyrotoxicosis is due to hyperthyroidism, a term reserved for disorders characterized by overproduction of thyroid hormones by the thyroid gland. Nevertheless, thyrotoxicosis may also result from a variety of conditions other than thyroid hyperfunction. The present report focuses on the etiologies, pathophysiology, and treatment of iatrogenic thyrotoxicosis. Iatrogenic thyrotoxicosis may be caused by (1) subacute thyroiditis (a result of lymphocytic infiltration, cellular injury, trauma, irradiation) with release of preformed hormones into circulation; (2) excessive ingestion of thyroid hormones ("thyrotoxicosis factitia"); (3) iodine-induced hyperthyroidism (radiologic contrast agents, topical antiseptics, other medications). Among these causes of iatrogenic thyrotoxicosis, that induced by the iodine overload and cytotoxicity associated with amiodarone represents a significant challenge. Successful management of amiodarone-induced thyrotoxicosis requires close cooperation between endocrinologists and endocrine surgeons. Surgical treatment may have a leading yet often underestimated role in view of the potential life-threatening severity of this disease, whereas others kinds of iatrogenic thyrotoxicosis are usually treated conservatively.
甲状腺毒症是机体组织暴露于高水平循环甲状腺激素时所产生的临床综合征。在大多数情况下，甲状腺毒症是由甲状腺功能亢进引起的，甲状腺功能亢进是一个专门用于描述甲状腺激素过度分泌的疾病的术语。然而，甲状腺毒症也可能由甲状腺功能亢进以外的多种情况引起。本报告重点关注医源性甲状腺毒症的病因、病理生理学和治疗。医源性甲状腺毒症可能由以下原因引起：（1）亚急性甲状腺炎（淋巴细胞浸润、细胞损伤、创伤、辐射的结果），导致预先形成的激素释放进入循环；（2）过量摄入甲状腺激素（“人为性甲状腺毒症”）；（3）碘诱导的甲状腺功能亢进（放射造影剂、局部防腐剂、其他药物）。在这些医源性甲状腺毒症的病因中，由胺碘酮相关的碘负荷和细胞毒性引起的甲状腺毒症是一个重大挑战。胺碘酮诱导的甲状腺毒症的成功管理需要内分泌学家和内分泌外科医生密切合作。鉴于这种疾病潜在的危及生命的严重性，手术治疗可能具有主导作用，但往往被低估，而其他类型的医源性甲状腺毒症通常采用保守治疗。
