Department of Endocrinology and Metabolism, University of Pisa, Ospedale Cisanello, Via Paradisa, 2, 56124 Pisa, Italy.
J Clin Endocrinol Metab. 2011 Nov;96(11):3374-80. doi: 10.1210/jc.2011-1678. Epub 2011 Aug 24.
Type 2 amiodarone-induced thyrotoxicosis (AIT) is a destructive thyroiditis usually responsive to glucocorticoids. Whether continuation of amiodarone affects treatment outcome is unsettled.
The objective of the study was to compare the outcome of glucocorticoid treatment in type 2 AIT patients who continued or withdrew amiodarone.
This was a matched retrospective cohort study.
The study was conducted at a university center.
Eighty-three consecutive patients with untreated type 2 AIT participated in the study. After matching with patients continuing amiodarone (AMIO-ON, n = 8), patients interrupting amiodarone were randomly selected in a 4:1 ratio (AMIO-OFF, n = 32).
All patients were treated with oral prednisone. Patients whose thyrotoxicosis recurred after glucocorticoid withdrawal were treated with a second course of prednisone.
Time and rate of cure were measured.
Median time to the first normalization of serum thyroid hormone levels did not significantly differ in AMIO-ON and AMIO-OFF patients (24 and 31 d, respectively; P = 0.326). Conversely, median time for stably restoring euthyroidism was 140 d in AMIO-ON patients and 47 d in AMIO-OFF patients (log rank, P = 0.011). In fact, AIT recurred in five of seven AMIO-ON patients (71.4%) and in only three of 32 AMIO-OFF patients (9.4%, P = 0.002), requiring readministration of prednisone. One AMIO-ON patient never reached thyroid hormone normalization during the study period. Factors associated with glucocorticoid failure were thyroid volume and amiodarone continuation.
Prednisone restores euthyroidism in most type 2 AIT patients, irrespective of amiodarone continuation or withdrawal. However, continuing amiodarone increases the recurrence rate of thyrotoxicosis, causing a delay in the stable restoration of euthyroidism and a longer exposure of the heart to thyroid hormone excess.
2 型胺碘酮诱导的甲状腺功能亢进症（AIT）是一种破坏性甲状腺炎，通常对糖皮质激素有反应。继续使用胺碘酮是否会影响治疗结果尚无定论。
本研究旨在比较继续或停用胺碘酮的 2 型 AIT 患者糖皮质激素治疗的结果。
这是一项匹配的回顾性队列研究。
该研究在一个大学中心进行。
83 例未经治疗的 2 型 AIT 患者参与了研究。在与继续使用胺碘酮的患者（AMIO-ON，n = 8）匹配后，以 4:1 的比例随机选择中断胺碘酮的患者（AMIO-OFF，n = 32）。
所有患者均接受口服泼尼松治疗。糖皮质激素停药后甲状腺功能亢进复发的患者接受第二疗程泼尼松治疗。
测量治愈时间和治愈率。
AMIO-ON 和 AMIO-OFF 患者血清甲状腺激素水平首次正常化的中位时间无显著差异（分别为 24 和 31 d，P = 0.326）。相反，AMIO-ON 患者稳定恢复甲状腺功能正常的中位时间为 140 d，而 AMIO-OFF 患者为 47 d（对数秩检验，P = 0.011）。事实上，7 例 AMIO-ON 患者中有 5 例（71.4%）AIT 复发，而 32 例 AMIO-OFF 患者中只有 3 例（9.4%）复发，需要重新服用泼尼松（P = 0.002）。1 例 AMIO-ON 患者在研究期间从未达到甲状腺激素正常化。与糖皮质激素治疗失败相关的因素包括甲状腺体积和胺碘酮的继续使用。
泼尼松可使大多数 2 型 AIT 患者恢复甲状腺功能正常，无论是否继续使用胺碘酮。然而，继续使用胺碘酮会增加甲状腺功能亢进症复发的风险，导致甲状腺功能正常的稳定恢复延迟，并使心脏更长时间暴露于甲状腺激素过多。
