Bogazzi Fausto, Tomisti Luca, Di Bello Vitantonio, Martino Enio
Unità di Endocrinologia, Dipartimento di Medicina Clinica e Sperimentale, Università degli Studi, Pisa.
Sezione Dipartimentale Universitaria di Cardio-Angiologia, Ospedale di Cisanello, Università degli Studi, Pisa.
G Ital Cardiol (Rome). 2017 Mar;18(3):219-229. doi: 10.1714/2674.27399.
Amiodarone-induced thyroid dysfunction occurs in about 15-20% of patients under amiodarone therapy. Amiodarone-induced hypothyroidism (AIH) can develop in patients with an apparently normal thyroid gland or in those with an underlying chronic autoimmune thyroiditis. On a clinical ground, AIH is not challenging and can be easily treated with L-thyroxine therapy. Amiodarone-induced thyrotoxicosis (AIT) can occur in patients with (AIT 1) or without (AIT 2) an underlying thyroid disease. AIT 1 is a true iodine-induced hyperthyroidism occurring in patients with an underlying thyroid autonomy while AIT 2 is a drug-induced destructive thyroiditis. According to the different pathogenetic mechanism, AIT 2 is treated with glucocorticoids while AIT 1 usually responds to thionamides. Thyroidectomy should be considered when AIT represents an imminent risk for cardiac conditions, when patients require a prompt resolution of thyrotoxicosis or when they do not respond to the medical therapy. An effective collaboration between cardiologists and endocrinologists is crucial in each part of the management of AIT patients, including the evaluation of cardiological conditions with regard to thyroid hormone excess and whether, or not, it is necessary to continue amiodarone therapy.
胺碘酮所致甲状腺功能障碍发生于约15% - 20%接受胺碘酮治疗的患者中。胺碘酮所致甲状腺功能减退（AIH）可发生于甲状腺看似正常的患者或患有潜在慢性自身免疫性甲状腺炎的患者。在临床上，AIH并不具有挑战性，用左旋甲状腺素治疗即可轻松应对。胺碘酮所致甲状腺毒症（AIT）可发生于患有（AIT 1）或未患有（AIT 2）潜在甲状腺疾病的患者。AIT 1是发生于潜在甲状腺自主性患者的真正碘致甲状腺功能亢进，而AIT 2是药物性破坏性甲状腺炎。根据不同的发病机制，AIT 2用糖皮质激素治疗，而AIT 1通常对硫代酰胺类药物有反应。当AIT对心脏状况构成紧迫风险、患者需要迅速缓解甲状腺毒症或对药物治疗无反应时，应考虑行甲状腺切除术。在AIT患者管理的各个环节，心脏病专家和内分泌专家之间的有效协作至关重要，包括评估甲状腺激素过量对心脏状况的影响以及是否有必要继续胺碘酮治疗。
