Opalińska Marta, Pantofliński Jacek, Sokołowski Grzegorz, Pach Dorota, Kostecka-Matyja Marta, Żabicka Katarzyna, Partyński Bartosz, Kieć-Klimczak Małgorzata, Sowa-Staszczak Anna, Buziak-Bereza Monika, Gilis-Januszewska Aleksandra, Hubalewska-Dydejczyk Alicja
Chair and Department of Endocrinology, Jagiellonian University Medical College, ul. Jakubowskiego 2, 30-688, Krakow, Poland.
Nuclear Medicine Unit, Endocrinology, Oncological Endocrinology and Nuclear Medicine Department, University Hospital, ul. Jakubowskiego 2, 30-688, Krakow, Poland.
Heliyon. 2024 Jul 18;10(14):e34850. doi: 10.1016/j.heliyon.2024.e34850. eCollection 2024 Jul 30.
Amiodarone is an iodine-rich molecule and an effective antiarrhythmic drug. It is a first-line treatment for patients with life-threatening ventricular arrhythmias and for prevention in patients at high risk. The use of amiodarone may cause serious adverse effects such as pharmacotherapy-resistant, life-threatening amiodarone-induced thyrotoxicosis (AIT)leading to rapid deterioration of the patient's condition.According to the European Thyroid Association (ETA) guidelines, emergency thyroidectomy is the first-line treatment option in these cases. ; however, is not always feasible in the clinical setting due to the high anesthetic risk.We aimed to assess the clinical course and results of urgent thyroidectomy and 131-I therapy in patients with severe AIT with worsening of cardiac status.
Retrospective analysis of the clinical course and outcomes of life-threatening AIT refractory to pharmacotherapy in patients hospitalized at a tertiary endocrinology center between 2014 and 2022.
An electronic database search identified 75 patients hospitalized for severe AIT. At the time of AIT diagnosis, median Thyroid-stimulating hormone (TSH) concentration was 0.001 mIU/L (range 0.001-0.35), fT4 63.2 pmol/L (range 9.0 - >100), and fT3 10.2 pmol/L (range 3.8-49.3). All patients received optimal conservative treatment. Among them, 20 required urgent radical therapy due to worsening arrhythmias and/or AIT-related heart failure. In this group, 6 patients died before any radical treatment was applied, 6 underwent total thyroidectomy, while 8 patients were successfully treated with 131-I (in 6 cases after rhTSH stimulation). The median dose of 131-I used for the therapy was 784MBq (range 627-860). The decision to treat with 131-I despite low but detectable 131-I uptake (median value 6 %) was made in cases of significant contraindications to anesthesia due to refractory ventricular arrhythmias, exacerbation of severe heart failure unresponsive to cardiac treatment, myocardial infarction during AIT course, massive pulmonary embolism.
The decision regarding the optimal time and type of radical treatment of AIT refractory to pharmacotherapy is critical for patients management and should not be delayed. Urgent therapy with 131-I may be an effective therapeutic option in patients who are unsuitable for thyroidectomy due to the high risk of anesthesia.
胺碘酮是一种富含碘的分子，是一种有效的抗心律失常药物。它是治疗危及生命的室性心律失常患者和高危患者预防的一线治疗方法。使用胺碘酮可能会引起严重的不良反应，如药物治疗抵抗、危及生命的胺碘酮诱发的甲状腺毒症（AIT），导致患者病情迅速恶化。根据欧洲甲状腺协会（ETA）指南，紧急甲状腺切除术是这些病例的一线治疗选择；然而，由于麻醉风险高，在临床环境中并不总是可行的。我们旨在评估严重AIT伴心脏状态恶化患者紧急甲状腺切除术和131-I治疗的临床过程和结果。
回顾性分析2014年至2022年在一家三级内分泌中心住院的药物治疗难治性危及生命的AIT患者的临床过程和结局。
电子数据库搜索确定75例因严重AIT住院的患者。在AIT诊断时，促甲状腺激素（TSH）浓度中位数为0.001 mIU/L（范围0.001-0.35），游离甲状腺素（fT4）63.2 pmol/L（范围9.0->100），游离三碘甲状腺原氨酸（fT3）10.2 pmol/L（范围3.8-49.3）。所有患者均接受了最佳保守治疗。其中，20例因心律失常恶化和/或AIT相关心力衰竭需要紧急根治性治疗。在该组中，6例患者在进行任何根治性治疗前死亡，6例接受了全甲状腺切除术，8例患者成功接受了131-I治疗（6例在重组人促甲状腺素刺激后）。用于治疗的131-I中位剂量为784MBq（范围627-860）。尽管131-I摄取率低但可检测到（中位数为6%），但在因难治性室性心律失常导致麻醉存在重大禁忌证、心脏治疗无效的严重心力衰竭加重、AIT病程中发生心肌梗死、大面积肺栓塞的情况下，仍决定使用131-I进行治疗。
对于药物治疗难治性AIT的最佳根治治疗时间和类型的决策对于患者管理至关重要，不应延迟。对于因麻醉风险高而不适合甲状腺切除术的患者，紧急131-I治疗可能是一种有效的治疗选择。
