Division of Pediatric Endocrinology and Metabolism, Mayo Clinic, Rochester, Minnesota.
Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota.
Heart Rhythm. 2019 Sep;16(9):1436-1442. doi: 10.1016/j.hrthm.2019.03.015. Epub 2019 Mar 21.
Heart Rhythm Society guidelines recommend obtaining thyroid function tests (TFTs) at amiodarone initiation and every 6 months thereafter in adults, with no specific pediatric recommendations. Untreated hypothyroidism in young children negatively affects brain development and somatic growth, yet the optimal screening frequency for pediatric patients remains unclear, and limited data exist on pediatric amiodarone-induced thyroid dysfunction.
The purpose of this study was to describe the patterns of amiodarone-induced thyroid dysfunction in pediatric patients.
We established a retrospective cohort of 527 pediatric patients who received amiodarone between 1997 and 2017. We defined amiodarone therapy lasting 3-30 days as "short term" and >30 days as "long term."
The final cohort (n = 150) consisted of 27 neonates (18%), 25 infants (16%), 27 young children (18%), and 71 children (47%). Of the children in whom TFTs were checked, half (50.8%) developed a thyroid-stimulating hormone (TSH) value above the reference for age. Neonates had the highest median peak TSH values in both short- and long-term groups: 23.5 mIU/L (interquartile range 11.4-63.1) and 28.8 mIU/L (interquartile range 11.4-34.4), respectively. Although concurrent use of inotropic support was significantly associated with lower initial TSH values, no variable related to cardiac illness or type of heart disease was associated with peak TSH values.
Neonates and infants receiving amiodarone had more thyroid dysfunction with greater degrees of TSH elevation than older children. TSH elevations occurred early, even with short-term exposure. Given the concern for brain development and growth in hypothyroid children, our results suggest the need for more rigorous pediatric-specific thyroid monitoring guidelines.
美国心律学会指南建议在开始使用胺碘酮时以及此后每 6 个月进行甲状腺功能测试（TFTs），但没有针对儿科的具体建议。幼儿期未治疗的甲状腺功能减退症会对大脑发育和身体生长产生负面影响，但儿科患者的最佳筛查频率仍不清楚，并且有关儿科胺碘酮引起的甲状腺功能障碍的数据有限。
本研究的目的是描述儿科患者中胺碘酮引起的甲状腺功能障碍的模式。
我们建立了一个回顾性队列，其中包括 1997 年至 2017 年间接受胺碘酮治疗的 527 名儿科患者。我们将胺碘酮治疗持续 3-30 天定义为“短期”，>30 天定义为“长期”。
最终队列（n = 150）包括 27 例新生儿（18%），25 例婴儿（16%），27 例幼儿（18%）和 71 例儿童（47%）。在检查了 TFT 的儿童中，有一半（50.8%）的甲状腺刺激激素（TSH）值超过了年龄参考值。新生儿在短期和长期组中的 TSH 峰值中位数均最高：分别为 23.5 mIU/L（四分位距 11.4-63.1）和 28.8 mIU/L（四分位距 11.4-34.4）。尽管同时使用正性肌力支持与较低的初始 TSH 值显著相关，但与心脏疾病或心脏病类型相关的任何变量均与 TSH 峰值无关。
接受胺碘酮治疗的新生儿和婴儿发生甲状腺功能障碍的程度比年龄较大的儿童更严重，并且 TSH 升高的程度更大。即使短期暴露，TSH 升高也会较早发生。鉴于甲状腺功能减退儿童的大脑发育和生长的担忧，我们的结果表明需要制定更严格的儿科特异性甲状腺监测指南。
