Uzan Laurent, Guignat Laurence, Meune Christophe, Mouly Stéphane, Weber Simon, Bertagna Xavier, Bertherat Jérôme, Thomopoulos Pierre, Duboc Denis
Department of Cardiology, Cochin Hospital, Rene Descartes University, Paris, France.
Drug Saf. 2006;29(3):231-6. doi: 10.2165/00002018-200629030-00006.
Amiodarone is a powerful antiarrhythmic drug; however, its use may be complicated by thyrotoxicosis. When this occurs, clinicians must balance the continuation of amiodarone for antiarrhythmic purposes, and the discontinuation of treatment in order to prevent aggravation of the thyrotoxicosis. We studied the consequences of continuation or cessation of amiodarone in patients with type II amiodarone-induced thyrotoxicosis.
Consecutive patients who developed type II amiodarone-induced thyrotoxicosis between September 1997 and September 2000 were studied. Amiodarone was continued in patients with previous ventricular arrhythmia or supraventricular arrhythmia associated with severe haemodynamic changes and was withdrawn in the other patients. In patients with persistent, severe symptomatic thyrotoxicosis, corticosteroids were added to therapy.
Thirteen patients were studied (nine with previous atrial fibrillation/flutter and four with ventricular tachycardia). Amiodarone treatment was continued in ten patients, including eight patients who received corticosteroids, and was temporarily halted in three patients. All patients recovered, with no difference in the duration of thyrotoxicosis between the two groups. Corticosteroid treatment was well tolerated and seemed to hasten the return to a euthyroid state (mean of 3.7 +/- 0.7 months vs 6.3 +/- 1.7 months). No recurrence of hyperthyroidism occurred during long-term follow-up.
In patients who require amiodarone, treatment may be safely continued despite the development of type II amiodarone-induced thyrotoxicosis.
胺碘酮是一种强效抗心律失常药物；然而，其使用可能会因甲状腺毒症而变得复杂。当这种情况发生时，临床医生必须在为抗心律失常目的继续使用胺碘酮和停止治疗以防止甲状腺毒症加重之间进行权衡。我们研究了II型胺碘酮诱发的甲状腺毒症患者继续或停用胺碘酮的后果。
对1997年9月至2000年9月期间发生II型胺碘酮诱发的甲状腺毒症的连续患者进行研究。既往有室性心律失常或伴有严重血流动力学改变的室上性心律失常的患者继续使用胺碘酮，其他患者停用。对于持续存在严重症状性甲状腺毒症的患者，在治疗中加用皮质类固醇。
研究了13例患者（9例既往有房颤/房扑，4例有室性心动过速）。10例患者继续使用胺碘酮治疗，其中8例接受了皮质类固醇治疗，3例患者暂时停药。所有患者均康复，两组甲状腺毒症持续时间无差异。皮质类固醇治疗耐受性良好，似乎能加速恢复到甲状腺功能正常状态（平均3.7±0.7个月对6.3±1.7个月）。长期随访期间未发生甲亢复发。
对于需要使用胺碘酮的患者，尽管发生了II型胺碘酮诱发的甲状腺毒症，但治疗仍可安全继续。
