Department of Clinical and Experimental Medicine, Unit of Endocrinology, University of Pisa, Ospedale Cisanello, via Paradisa 2, 56124, Pisa, Italy.
Department of Medicine and Surgery, University of Insubria, Varese, Italy.
J Endocrinol Invest. 2020 Nov;43(11):1637-1643. doi: 10.1007/s40618-020-01252-2. Epub 2020 Apr 16.
Type 2 amiodarone-induced thyrotoxicosis (AIT2) is a form of drug-induced destructive thyroiditis, usually treated with oral glucocorticoids (oGCs). Our objective was to investigate the short-term effects of intravenous glucocorticoids (ivGCs) on serum thyroid hormone concentrations in patients with AIT2.
Exploratory study of three naive AIT2 patients treated with iv methylprednisolone (two pulses of 400 mg with no interpulse oGCs), followed by oGCs, matched 1:3 with AIT2 patients treated with oGCs alone. Changes in serum thyroid hormone concentrations were evaluated in the short-term period (24 h and 7 days) and after a cumulative dosage of 400 and 800 mg equivalents of methylprednisolone; in addition, healing time and duration of exposure to GCs were calculated.
During the first 24 h of treatment, serum FT4 concentrations increased in ivGCs patients, and decreased in oGCs patients (+ 3.3% vs - 10.7%, respectively, p = 0.025). After 7 days, serum FT4 and FT3 concentrations decreased significantly in both groups, with no statistical difference between them (p = 0.439 for FT4 and p = 0.071 for FT3), even though the cumulative GCs dose was higher in ivGCs than in oGCs patients (800 mg vs 280 mg, p = 0.008). Furthermore, the iv administration of single 400 mg pulses of methylprednisolone resulted in a less significant decrease in serum thyroid hormone concentrations when compared to equivalent GCs doses fractionated in several consecutive days (p = 0.021 for FT4 and p = 0.052 for FT3). There were no significant differences in the healing time (p = 0.239) and duration of exposure to GCs (p = 0.099).
High-dose ivGCs therapy does not offer advantages over standard oGCs therapy in the rapid, short-term control of AIT2.
2 型胺碘酮诱导的甲状腺机能亢进症（AIT2）是一种药物诱导的破坏性甲状腺炎，通常采用口服糖皮质激素（oGCs）治疗。我们的目的是研究静脉内糖皮质激素（ivGCs）对 AIT2 患者血清甲状腺激素浓度的短期影响。
对 3 例初次诊断为 AIT2 的患者进行探索性研究，他们接受静脉注射甲泼尼龙（2 个 400mg 脉冲，脉冲之间无 oGCs），随后给予 oGCs 治疗，与单独使用 oGCs 治疗的 AIT2 患者按 1:3 匹配。在短期（24 小时和 7 天）和使用 400 和 800mg 甲泼尼龙等效剂量后，评估血清甲状腺激素浓度的变化；此外，还计算了愈合时间和接触 GCs 的持续时间。
在治疗的前 24 小时内，ivGCs 组患者的游离甲状腺素（FT4）浓度增加，而 oGCs 组患者的 FT4 浓度降低（分别为+3.3%和-10.7%，p=0.025）。7 天后，两组患者的血清 FT4 和 FT3 浓度均显著下降，但两组之间无统计学差异（FT4 为 p=0.439，FT3 为 p=0.071），尽管 ivGCs 组患者的累积 GCs 剂量高于 oGCs 组（800mg 对 280mg，p=0.008）。此外，与连续几天分剂量给予等效 GCs 相比，单次静脉注射 400mg 甲泼尼龙脉冲可使血清甲状腺激素浓度下降不那么显著（FT4 为 p=0.021，FT3 为 p=0.052）。愈合时间（p=0.239）和接触 GCs 的持续时间（p=0.099）无显著差异。
高剂量 ivGCs 治疗在 AIT2 的快速短期控制方面并不优于标准 oGCs 治疗。
