Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada.
BMJ Case Rep. 2024 Sep 3;17(9):e259860. doi: 10.1136/bcr-2024-259860.
Amiodarone is an antiarrhythmic drug which may be associated with thyroid dysfunction. Type I amiodarone-induced thyrotoxicosis (AIT) is treated with thionamides and type II AIT is treated with glucocorticoids. Combined therapy is used in mixed or indeterminate forms. When medical treatment is unsuccessful, radioiodine ablation or thyroidectomy is considered. This report reviews a case of AIT refractory to conventional treatment. Despite high doses of methimazole and prednisone, the patient remained clinically and biochemically thyrotoxic. Cholestyramine, a bile salt sequestrant, was used as an off-label adjunctive treatment resulting in significant improvement and achievement of euthyroidism that may also be in part due to the expected natural timeline of recovery from AIT after several months. The patient subsequently trended towards hypothyroidism with symptomatic weight gain and cold intolerance for which he was initiated on levothyroxine.
胺碘酮是一种抗心律失常药物，可能与甲状腺功能障碍有关。I 型胺碘酮诱导的甲状腺功能亢进症（AIT）用硫脲类药物治疗，II 型 AIT 用糖皮质激素治疗。混合或不确定形式采用联合治疗。当药物治疗无效时，考虑放射性碘消融或甲状腺切除术。本报告回顾了一例对常规治疗无效的 AIT 病例。尽管使用了大剂量的甲巯咪唑和泼尼松，但患者仍处于临床和生化甲状腺毒症状态。考来烯胺，一种胆汁盐螯合剂，被用作非适应证辅助治疗，结果显著改善并达到甲状腺功能正常，这可能部分归因于 AIT 在几个月后自然恢复的预期时间。此后，患者出现亚临床甲状腺功能减退症，表现为体重增加和畏寒，因此开始服用左甲状腺素。
