使用碘番酸进行预处理可在甲状腺切除术之前迅速控制胺碘酮所致甲状腺毒症患者的甲状腺毒症。

Preparation with iopanoic acid rapidly controls thyrotoxicosis in patients with amiodarone-induced thyrotoxicosis before thyroidectomy.

作者信息

Bogazzi Fausto, Miccoli Paolo, Berti Piero, Cosci Chiara, Brogioni Sandra, Aghini-Lombardi Fabrizio, Materazzi Gabriele, Bartalena Luigi, Pinchera Aldo, Braverman Lewis E, Martino Enio

机构信息

Department of Endocrinology and Metabolism, University of Pisa, Cisanello Hospital, Via Paradisa 2, 56124 Pisa, Italy.

出版信息

Surgery. 2002 Dec;132(6):1114-7; discussion 1118. doi: 10.1067/msy.2002.128561.

DOI:10.1067/msy.2002.128561

PMID:12490863

Abstract

BACKGROUND

Amiodarone-induced thyrotoxicosis (AIT) may develop either in apparently normal glands (type II AIT) or in the presence of thyroid abnormalities (type I AIT). Sometimes AIT is resistant to conventional treatment. Thyroidectomy was used in patients with AIT, but in patients who are thyrotoxic it may be hazardous. METHODS; Seven patients with AIT (6 type I and 1 type II, 5 men, 2 women, mean age 70 years [range, 60-82 years]) were prepared for total thyroidectomy with a short course of iopanoic acid (1 g/day orally for a mean of 13 days), an oral iodinated cholecystographic agent inhibiting 5'-deiodinase and causing a reduction in the peripheral conversion of thyroxine to triiodothyronine. Mean thyroid volume was 64 mL (range, 10-145 mL).

RESULTS

Mean serum-free triiodothyronine levels decreased from 20 +/- 16.7 pmol/L to 6 +/- 2 pmol/L (P =.0004), whereas serum-free thyroxine values remained unchanged. Euthyroidism was rapidly (7-20 days) restored, allowing an uncomplicated total thyroidectomy in all patients and the ability to continue amiodarone therapy in 6 patients. None had increased surgical bleeding, recurrent nerve palsy, or hypoparathyroidism. No cardiovascular complications occurred.

CONCLUSIONS

Iopanoic acid is an effective drug allowing rapid control of hyperthyroidism in AIT.

摘要

背景

胺碘酮所致甲状腺毒症（AIT）可在甲状腺外观正常时发生（II型AIT），也可在存在甲状腺异常时发生（I型AIT）。有时AIT对传统治疗有抵抗性。甲状腺切除术曾用于AIT患者，但对于甲状腺毒症患者可能具有危险性。方法：7例AIT患者（6例I型和1例II型，5例男性，2例女性，平均年龄70岁[范围60 - 82岁]）接受了短疗程碘番酸（每天口服1 g，平均13天）准备行全甲状腺切除术，碘番酸是一种口服胆囊造影碘剂，可抑制5'-脱碘酶并减少甲状腺素向三碘甲状腺原氨酸的外周转化。平均甲状腺体积为64 mL（范围10 - 145 mL）。

结果

平均血清游离三碘甲状腺原氨酸水平从20±16.7 pmol/L降至6±2 pmol/L（P = 0.0004），而血清游离甲状腺素值保持不变。甲状腺功能正常迅速（7 - 20天）恢复，所有患者均顺利进行了全甲状腺切除术，6例患者能够继续胺碘酮治疗。无一例出现手术出血增加、喉返神经麻痹或甲状旁腺功能减退。未发生心血管并发症。