Endocrinology UnitDepartment of Clinical and Experimental Medicine, University of Pisa, Ospedale Cisanello, Via Paradisa, 2, 56124 Pisa, ItalyEndocrine UnitDepartment of Clinical and Experimental Medicine, University of Insubria, 21100 Varese, ItalyUnit of Epidemiology and BiostatisticsInstitute of Clinical Physiology, National Research Council, 56184 Pisa, Italy.
Endocrinology UnitDepartment of Clinical and Experimental Medicine, University of Pisa, Ospedale Cisanello, Via Paradisa, 2, 56124 Pisa, ItalyEndocrine UnitDepartment of Clinical and Experimental Medicine, University of Insubria, 21100 Varese, ItalyUnit of Epidemiology and BiostatisticsInstitute of Clinical Physiology, National Research Council, 56184 Pisa, Italy
Eur J Endocrinol. 2014 Sep;171(3):363-8. doi: 10.1530/EJE-14-0267. Epub 2014 Jun 16.
Considering the different pathogenic mechanisms of the two main forms of amiodarone-induced thyrotoxicosis (AIT), we ascertained whether this results in a different onset time as well.
We retrospectively analyzed the clinical records of 200 consecutive AIT patients (157 men and 43 women; mean age 62.2±12.6 years) referred to our Department from 1987 to 2012. The onset time of AIT was defined as the time elapsed from the beginning of amiodarone therapy and the first diagnosis of thyrotoxicosis, expressed in months. Factors associated with the onset time of AIT were evaluated by univariate and multivariate analyses.
The median onset time of thyrotoxicosis was 3.5 months (95% CI 2-6 months) in patients with type 1 AIT (AIT1) and 30 months (95% CI 27-32 months, P<0.001) in those with type 2 AIT (AIT2). Of the total number of patients, 5% with AIT1 and 23% with AIT2 (P=0.007) developed thyrotoxicosis after amiodarone withdrawal. Factors affecting the onset time of thyrotoxicosis were the type of AIT and thyroid volume (TV).
The different pathogenic mechanisms of the two forms of AIT account for different onset times of thyrotoxicosis in the two groups. Patients with preexisting thyroid abnormalities (candidate to develop AIT1) may require a stricter follow-up during amiodarone therapy than those usually recommended. In AIT1, the onset of thyrotoxicosis after amiodarone withdrawal is rare, while AIT2 patients may require periodic tests for thyroid function longer after withdrawing amiodarone.
鉴于胺碘酮诱导性甲状腺毒症（AIT）的两种主要形式的发病机制不同，我们确定这是否也导致发病时间不同。
我们回顾性分析了 1987 年至 2012 年期间我院收治的 200 例连续 AIT 患者（157 名男性和 43 名女性；平均年龄 62.2±12.6 岁）的临床记录。AIT 的发病时间定义为从开始胺碘酮治疗到首次诊断为甲状腺毒症之间的时间，以月表示。通过单因素和多因素分析评估与 AIT 发病时间相关的因素。
1 型 AIT（AIT1）患者的甲状腺毒症中位发病时间为 3.5 个月（95%CI 2-6 个月），2 型 AIT（AIT2）患者为 30 个月（95%CI 27-32 个月，P<0.001）。在所有患者中，5%的 AIT1 和 23%的 AIT2（P=0.007）在停用胺碘酮后发生甲状腺毒症。影响甲状腺毒症发病时间的因素是 AIT 的类型和甲状腺体积（TV）。
两种形式的 AIT 的不同发病机制导致两组甲状腺毒症的发病时间不同。有甲状腺异常（易发生 AIT1）的患者在胺碘酮治疗期间可能需要比通常建议的更严格的随访。在 AIT1 中，停药后甲状腺毒症的发病罕见，而 AIT2 患者可能需要在停用胺碘酮后更长时间进行甲状腺功能的定期检查。
