Department of Internal Medicine, Division of Endocrinology, Mayo Clinic, Rochester, MN 55905, United States.
Int J Cardiol. 2013 Aug 10;167(3):821-6. doi: 10.1016/j.ijcard.2012.02.015. Epub 2012 Mar 2.
Amiodarone-induced thyrotoxicosis (AIT) is a recognized complication of amiodarone treatment with limited management options. Its predisposing factors are incompletely defined yet a higher prevalence was reported in adults with congenital heart disease (CHD). Therefore we sought to determine the incidence and risk factors for AIT in adults with CHD.
At a tertiary care center we followed a historical cohort of amiodarone-treated CHD patients for the period 1987-2009. Follow-up concluded at AIT diagnosis or with last thyroid assessment on amiodarone. Cumulative incidence of AIT was calculated. AIT association with nutritional status was hypothesized a priori.
AIT developed in 23/169 patients or 13.6%. The AIT incidence peaked in the 3rd year at 7.7%. AIT patients had a lower body mass index (BMI) at AMIO initiation compared with the rest of the cohort (mean ± standard deviation: 21.9 ± 2.9 vs. 25.1 ± 5.0; p<0.001). Patients with BMI<21 were more likely to develop thyrotoxicosis (RR=6.1) compared to those with BMI>25 (p<0.001). Presence of goiter was strongly associated with AIT (RR 3.6, p=0.002). Affected patients had a trend for higher cyanotic heart disease prevalence (34.8% vs. 17.8%, p=0.059). On multivariate analysis body mass index and goiter remained independent predictors of outcome.
BMI<21 at initiation of amiodarone therapy and presence of goiter are strong predictors of AIT in this population. Its incidence is time dependent. These predictors can be used clinically in assessing overall impact of amiodarone therapy in congenital heart disease patients.
胺碘酮诱导的甲状腺功能亢进症（AIT）是胺碘酮治疗的一种公认的并发症，其治疗方法有限。其诱发因素尚未完全明确，但在患有先天性心脏病（CHD）的成年人中，其发病率更高。因此，我们试图确定 CHD 成年患者中 AIT 的发生率和危险因素。
在一家三级医疗中心，我们对 1987 年至 2009 年期间接受胺碘酮治疗的 CHD 患者进行了历史队列研究。随访至 AIT 诊断或胺碘酮治疗最后一次甲状腺评估结束。计算 AIT 的累积发生率。AIT 与营养状况的关系是预先假设的。
169 例患者中有 23 例（13.6%）发生 AIT。AIT 的发生率在第 3 年达到峰值，为 7.7%。与队列中的其他患者相比，AIT 患者在开始胺碘酮治疗时的体重指数（BMI）较低（平均值±标准差：21.9±2.9 与 25.1±5.0；p<0.001）。与 BMI>25 的患者相比，BMI<21 的患者发生甲状腺功能亢进的可能性更大（RR=6.1）（p<0.001）。甲状腺肿的存在与 AIT 强烈相关（RR 3.6，p=0.002）。受影响的患者患紫绀型心脏病的比例较高（34.8%与 17.8%，p=0.059）。多变量分析显示，BMI 和甲状腺肿仍然是独立的预测因素。
胺碘酮治疗开始时 BMI<21 和存在甲状腺肿是该人群发生 AIT 的强预测因素。其发生率与时间有关。这些预测因素可用于临床评估胺碘酮治疗对先天性心脏病患者的总体影响。
