Section of Endocrinology, Diabetes and Nutrition, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts, USA.
Curr Opin Endocrinol Diabetes Obes. 2020 Oct;27(5):329-334. doi: 10.1097/MED.0000000000000562.
Amiodarone-induced thyroid dysfunction is well established and commonly encountered but is associated with several diagnostic and management challenges. The present review discusses recent evidence published related to the effects of amiodarone on the thyroid gland and thyroid function.
Retrospective studies to evaluate amiodarone-induced thyroid dysfunction in children show the occurrence of potential clinically significant changes within 2 weeks of amiodarone initiation that may not be detected if standard adult guidelines for thyroid hormone monitoring are followed. A small study evaluating beta-glucuronidase activity in amiodarone-induced thyrotoxicosis (AIT) demonstrated higher levels in patients with AIT type 2 compared to type 1. New data have suggested the incidence of agranulocytosis may be higher in patients on thionamides with AIT compared to hyperthyroidism because of other causes. In a small study, investigators demonstrated the use of a combination of intravenous and oral steroids to treat refractory AIT which needs to be evaluated in further controlled trials. Finally, recent data demonstrated a possible mortality benefit of surgery over medical therapy for AIT in patients with moderate to severe reduction in left ventricular ejection fraction.
Recent research regarding the prevalence, diagnosis, and management of amiodarone-induced thyroid dysfunction were reviewed.
胺碘酮引起的甲状腺功能障碍已得到充分证实，且较为常见，但与许多诊断和管理挑战相关。本综述讨论了近期发表的与胺碘酮对甲状腺和甲状腺功能影响相关的证据。
评估儿童胺碘酮诱导性甲状腺功能障碍的回顾性研究显示，在开始胺碘酮治疗后 2 周内可能会发生潜在的临床显著变化，如果遵循标准的成人甲状腺激素监测指南，则可能无法检测到这些变化。一项评估胺碘酮诱导性甲状腺毒症（AIT）中β-葡糖苷酸酶活性的小型研究表明，2 型 AIT 患者的水平高于 1 型。新数据表明，与其他原因引起的甲状腺功能亢进症相比，AIT 患者使用硫脲类药物时粒细胞减少症的发生率可能更高。在一项小型研究中，研究人员证实了联合使用静脉和口服类固醇治疗难治性 AIT，这需要在进一步的对照试验中进行评估。最后，最近的数据表明，对于左心室射血分数中度至重度降低的 AIT 患者，手术治疗可能比药物治疗更有生存获益。
综述了近期关于胺碘酮诱导性甲状腺功能障碍的患病率、诊断和治疗的研究进展。
