Yamamoto Jennifer, Dostmohamed Hanifa, Schacter Isanne, Ariano Robert E, Houston Donald S, Lewis Brenda, Knoll Colleen, Katz Pamela, Zarychanski Ryan
Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
J Clin Apher. 2014 Jun;29(3):168-70. doi: 10.1002/jca.21309. Epub 2013 Nov 22.
Amiodarone is associated with thyroid dysfunction and life-threatening thyrotoxicosis. In medically refractory cases, or where medical therapy is contraindicated, thyroidectomy may be required. To decrease perioperative thyroid storm and to reduce overall surgical risk, apheresis may be considered preoperatively to restore euthyroidism.
We report a 46-year-old female with a history of cardiac arrhythmia and tachycardia-induced cardiomyopathy for which she received amiodarone. Months after discontinuation of amiodarone, the patient presented with wide complex tachycardia and symptoms of thyrotoxicosis. Laboratory testing confirmed severe thyrotoxicosis which was subsequently refractory to medical therapy. Total thyroidectomy was required. Following a total of 10 apheresis treatments, thyroid hormone levels were reduced to near normal levels and the patient's symptoms improved. Thyroidectomy was performed without intraoperative or postoperative complication.
In the setting of life-threatening, medically refractory amiodarone-induced thyrotoxicosis, therapeutic apheresis can effectively reduce thyroid hormone levels and restore a state of clinical and biochemical euthyroidism.
胺碘酮与甲状腺功能障碍及危及生命的甲状腺毒症有关。在药物治疗无效的情况下，或药物治疗禁忌时，可能需要进行甲状腺切除术。为减少围手术期甲状腺风暴并降低总体手术风险，术前可考虑进行血液成分单采以恢复甲状腺功能正常。
我们报告一名46岁女性，有心脏心律失常和心动过速性心肌病病史，为此接受了胺碘酮治疗。停用胺碘酮数月后，患者出现宽QRS波心动过速和甲状腺毒症症状。实验室检查证实为严重甲状腺毒症，随后药物治疗无效。需要进行全甲状腺切除术。总共进行10次血液成分单采治疗后，甲状腺激素水平降至接近正常水平，患者症状改善。甲状腺切除术未出现术中或术后并发症。
在危及生命、药物治疗无效的胺碘酮所致甲状腺毒症情况下，治疗性血液成分单采可有效降低甲状腺激素水平并恢复临床和生化甲状腺功能正常状态。
