Thyroid Center, Division of Endocrinology and Diabetes, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
J Clin Endocrinol Metab. 2019 Nov 1;104(11):5540-5546. doi: 10.1210/jc.2019-00990.
Amiodarone is used in patients with arrhythmias, but thyroid dysfunction [amiodarone-induced thyrotoxicosis (AIT) or amiodarone-induced hypothyroidism (AIH)] is a common adverse effect. As the onset of AIT and AIH has not been studied in children, the timing of dysfunction and long-term monitoring are not known in this population.
To describe the incidence and timing of amiodarone-induced thyroid dysfunction in children and adolescents, with a secondary aim to identify risk factors for amiodarone-induced thyroid dysfunction, and to identify variance in thyroid hormone surveillance and treatment.
Retrospective review of thyroid dysfunction in children and young adults treated with amiodarone between 2007 and 2018.
Children's Hospital of Philadelphia.
Children and young adults treated with amiodarone.
Prevalence of amiodarone-induced thyroid dysfunction.
Of 484 patients, 190 had thyroid-function testing; 17.3% were found to have subclinical hypothyroidism, and 13.7% testing developed hypothyroidism. Hyperthyroidism occurred in 2.1%. In patients with subclinical hypothyroidism, 63% returned to normal thyroid function without thyroid hormone replacement. Only 26% of patients with hypothyroidism had spontaneous normalization of thyroid function. Twenty-five percent of AIT patients had spontaneous normalization of thyroid function.
This study looks at a pediatric and young-adult population in an effort to describe the natural history of amiodarone-induced thyroid dysfunction. Based on our data, we recommend that a complete thyroid-function panel be obtained within the first week and then at weekly intervals for the first 5 weeks after initiation. The majority of thyroid dysfunction was noted within the first 35 days of treatment.
胺碘酮常用于心律失常患者，但甲状腺功能障碍（胺碘酮诱导的甲状腺毒症[AIT]或胺碘酮诱导的甲状腺功能减退症[AIH]）是一种常见的不良反应。由于在儿童中尚未研究 AIT 和 AIH 的发病情况，因此在该人群中，甲状腺功能障碍的发生时间和长期监测尚不清楚。
描述儿童和青少年胺碘酮诱导的甲状腺功能障碍的发生率和发生时间，次要目的是确定胺碘酮诱导的甲状腺功能障碍的危险因素，并确定甲状腺激素监测和治疗的差异。
对 2007 年至 2018 年间接受胺碘酮治疗的儿童和青少年甲状腺功能障碍进行回顾性分析。
费城儿童医院。
接受胺碘酮治疗的儿童和青少年。
胺碘酮诱导的甲状腺功能障碍的发生率。
在 484 名患者中，有 190 名进行了甲状腺功能检测；17.3%的患者存在亚临床甲状腺功能减退，13.7%的患者出现甲状腺功能减退。发生甲状腺功能亢进 2.1%。在亚临床甲状腺功能减退患者中，63%的患者甲状腺功能恢复正常，无需甲状腺激素替代治疗。只有 26%的甲状腺功能减退患者甲状腺功能自发恢复正常。AIT 患者中有 25%的患者甲状腺功能自发恢复正常。
本研究着眼于儿科和青少年人群，旨在描述胺碘酮诱导的甲状腺功能障碍的自然史。根据我们的数据，我们建议在开始治疗后的第一周内获得完整的甲状腺功能检测结果，然后每周检测一次，共 5 周。大多数甲状腺功能障碍发生在治疗的前 35 天内。
