Endocrine Section, MedStar Washington Hospital Center, Washington, DC.
Faculty of Medicine, University of Medicine, Tirana, Albania.
J Clin Endocrinol Metab. 2021 Jan 1;106(1):226-236. doi: 10.1210/clinem/dgaa686.
Amiodarone is a class III antiarrhythmic drug containing 37% iodine by weight, with a structure similar to that of thyroid hormones. Deiodination of amiodarone releases large amounts of iodine that can impair thyroid function, causing either hypothyroidism or thyrotoxicosis in susceptible individuals reflecting ~20% of patients administered the drug. Not only the excess iodine, but also the amiodarone (or its metabolite, desethylamiodarone) itself may cause thyroid dysfunction by direct cytotoxicity on thyroid cells. We present an overview of the epidemiology and pathophysiology of amiodarone-induced thyroid disorders, with a focus on the various forms of clinical presentation and recommendations for personalized management of each form.
胺碘酮是一种含有 37%碘(按重量计)的 III 类抗心律失常药物,其结构与甲状腺激素相似。胺碘酮的脱碘作用会释放大量碘,可能会损害甲状腺功能,导致易感个体出现甲状腺功能减退或甲状腺功能亢进,反映出约 20%接受该药物治疗的患者会出现这种情况。不仅是过量的碘,胺碘酮(或其代谢物去乙基胺碘酮)本身也可能通过对甲状腺细胞的直接细胞毒性导致甲状腺功能障碍。我们概述了胺碘酮引起的甲状腺疾病的流行病学和病理生理学,重点介绍了各种临床表现形式,并针对每种形式提出了个性化管理的建议。