Department of Endocrinology and Metabolism, University of Pisa, Ospedale Cisanello, Via Paradisa, 2, 56124 Pisa, Italy.
J Clin Endocrinol Metab. 2012 Oct;97(10):3515-21. doi: 10.1210/jc.2012-1797. Epub 2012 Aug 3.
Patients with amiodarone-induced thyrotoxicosis (AIT) and left ventricular (LV) systolic dysfunction have a high mortality rate. Usually, medical therapy is the first choice for AIT patients, whereas the role of the thyroidectomy is unsettled.
The objective of the study was to evaluate the effect of a total thyroidectomy on cardiac function and survival of AIT patients with severe LV systolic dysfunction.
This was a retrospective cohort study.
The study was conducted at a tertiary university center.
All AIT patients (n=24; nine patients with type 1 AIT, 15 patients with type 2 AIT) referred to the Department of Endocrinology and submitted to a total thyroidectomy at the Department of Surgery, both at the University of Pisa, during the years 1997-2010.
The intervention was a total thyroidectomy.
LV ejection fraction (EF) after the thyroidectomy and survival in December 2011 were measured.
All enrolled patients had previously undergone to medical treatment for AIT, as appropriate, without achieving euthyroidism. Patients with moderate to severe LV systolic dysfunction (EF<40%, group 1, n=9) or with mild systolic dysfunction (40%≤EF≤50%, group 2, n=5) were compared with patients with normal systolic function (EF>50%, group 3, n=10). Two months after thyroidectomy, under levothyroxine replacement therapy, LVEF improved in patients with LV systolic dysfunction, particularly in those of group 1, in whom it increased from 28.2±7.2 to 38.3±6% (P=0.007). On the contrary, LVEF did not significantly change in group 3 (from 57.1±3.0 to 59.8±6.6%, P=0.242). The mean follow-up was 67±42 months. No death occurred during and 2 months after surgery. One death occurred in one patient of group 1, 30 months after the thyroidectomy, due to acute myocardial infarction. No patient had relevant complications of thyroidectomy.
Total thyroidectomy, by rapidly restoring euthyroidism, may improve cardiac function and reduce the risk of mortality in AIT patients with severe LV dysfunction.
患有胺碘酮诱导性甲状腺毒症（AIT）和左心室（LV）收缩功能障碍的患者死亡率很高。通常，医学治疗是 AIT 患者的首选，而甲状腺切除术的作用尚未确定。
本研究旨在评估全甲状腺切除术对伴有严重 LV 收缩功能障碍的 AIT 患者心功能和生存率的影响。
这是一项回顾性队列研究。
该研究在一所三级大学中心进行。
1997 年至 2010 年期间，所有被转介到比萨大学内分泌科并在外科行全甲状腺切除术的 AIT 患者（24 例；9 例为 1 型 AIT，15 例为 2 型 AIT）均被纳入研究。
干预措施为全甲状腺切除术。
甲状腺切除术后 LV 射血分数（EF）和 2011 年 12 月的生存率。
所有入组患者均曾接受过适当的 AIT 药物治疗，但未能达到甲状腺功能正常。将中重度 LV 收缩功能障碍（EF<40%，组 1，n=9）或轻度收缩功能障碍（40%≤EF≤50%，组 2，n=5）的患者与 LV 收缩功能正常（EF>50%，组 3，n=10）的患者进行比较。甲状腺切除术后 2 个月，在左甲状腺素替代治疗下，LV 收缩功能障碍患者的 LVEF 得到改善，尤其是组 1 的患者，其 LVEF 从 28.2±7.2%增加至 38.3±6%（P=0.007）。相反，组 3 的 LVEF 无显著变化（从 57.1±3.0%增加至 59.8±6.6%，P=0.242）。平均随访时间为 67±42 个月。手术期间和术后 2 个月均无死亡发生。1 例组 1 患者在甲状腺切除术后 30 个月死于急性心肌梗死。无患者发生与甲状腺切除术相关的并发症。
通过迅速恢复甲状腺功能正常，全甲状腺切除术可改善 AIT 伴有严重 LV 功能障碍患者的心功能，并降低死亡率。
