Department of Endocrinology and Metabolism, Academic Medical Center, University of Amsterdam, Amsterdam 1105AZ, The Netherlands.
J Clin Endocrinol Metab. 2012 Feb;97(2):499-506. doi: 10.1210/jc.2011-2390. Epub 2011 Nov 30.
Amiodarone-induced thyrotoxicosis (AIT) type 2 is self-limiting in nature, but most physicians are reluctant to continue amiodarone. When prednisone fails to restore euthyroidism, possibly due to mixed cases of AIT type 1 and 2, perchlorate (ClO(4)) might be useful because ClO(4) reduces the cytotoxic effect of amiodarone on thyrocytes.
Our objectives were to demonstrate the feasibility of continuation of amiodarone in AIT type 2 and to evaluate the usefulness of ClO(4) (given alone or in combination with prednisone) in AIT type 2.
A randomized multicenter study was conducted in 10 Dutch hospitals.
Patients with AIT type 2 were randomized to receive prednisone 30 mg/d (group A, n = 12), sodium perchlorate 500 mg twice daily (group B, n = 14), or prednisone plus perchlorate (group C, n = 10); all patients continued amiodarone and were also treated with methimazole 30 mg/d. Follow-up was 2 yr.
Treatment efficacy (defined as TSH values ≥ 0.4 mU/liter under continuation of amiodarone) and recurrent thyrotoxicosis were evaluated.
Initial therapy was efficacious in 100, 71, and 100% of groups A, B, and C, respectively (P = 0.03). The 29% failures in group B became euthyroid after addition of prednisone. Neither the time to reach TSH of 0.4 mU/liter or higher [8 wk (4-20), 14 wk (4-32), and 12 wk (4-28) in groups A, B, and C respectively] nor the time to reach free T(4) of 25 pmol/liter or below [4 wk (4-20), 12 wk (4-20), and 8 wk (4-20) in groups A, B, and C) were significantly different between groups (values as median with range). Recurrent thyrotoxicosis occurred in 8.3%.
Euthyroidism was reached despite continuation of amiodarone in all patients. Prednisone remains the preferred treatment modality of AIT type 2, because perchlorate given alone or in combination with prednisone had no better outcomes.
胺碘酮诱导的甲状腺毒症（AIT）2 型本质上是自限性的，但大多数医生不愿继续使用胺碘酮。当泼尼松未能恢复甲状腺功能正常时，可能由于 1 型和 2 型 AIT 混合病例，高氯酸盐（ClO4-）可能有用，因为 ClO4-可降低胺碘酮对甲状腺细胞的细胞毒性作用。
我们的目的是证明在 AIT 2 型中继续使用胺碘酮的可行性，并评估 ClO4-（单独或与泼尼松联合使用）在 AIT 2 型中的有效性。
在 10 家荷兰医院进行了一项随机多中心研究。
将 AIT 2 型患者随机分为泼尼松 30mg/d 组（A 组，n=12）、高氯酸钠 500mg 每日 2 次组（B 组，n=14）或泼尼松加高氯酸钠组（C 组，n=10）；所有患者继续服用胺碘酮，并接受甲巯咪唑 30mg/d 治疗。随访时间为 2 年。
评估治疗效果（定义为在继续使用胺碘酮的情况下 TSH 值≥0.4mU/l）和复发性甲状腺毒症。
A、B 和 C 组的初始治疗有效率分别为 100%、71%和 100%（P=0.03）。B 组的 29%治疗失败患者在加用泼尼松后恢复甲状腺功能正常。A、B 和 C 组达到 TSH 值≥0.4mU/l 的时间（分别为 8 周[4-20]、14 周[4-32]和 12 周[4-28]）或达到游离 T4 值<25pmol/l 的时间（分别为 4 周[4-20]、12 周[4-20]和 8 周[4-20]）均无显著差异（中位数及范围）。复发性甲状腺毒症发生率为 8.3%。
尽管所有患者继续使用胺碘酮，但均达到甲状腺功能正常。泼尼松仍然是 AIT 2 型的首选治疗方法，因为单独使用或联合使用高氯酸盐的效果没有更好。
