Martino E, Safran M, Aghini-Lombardi F, Rajatanavin R, Lenziardi M, Fay M, Pacchiarotti A, Aronin N, Macchia E, Haffajee C
Ann Intern Med. 1984 Jul;101(1):28-34. doi: 10.7326/0003-4819-101-1-28.
Amiodarone, an iodine-containing drug used frequently in the treatment of cardiac arrhythmias and angina pectoris, has many effects on thyroid hormone metabolism, including decreasing the production of triiodothyronine (T3) and decreasing the clearance of thyroxine and reverse T3. These effects result in elevated serum thyroxine and reverse T3 concentrations and decreased serum T3 concentrations. In addition, iodine-induced hyperthyroidism or hypothyroidism may occur in patients chronically treated with amiodarone. This study is a retrospective analysis of the incidence of thyroid dysfunction in Lucca and Pisa, West Tuscany, Italy, and in Worcester, Massachusetts. Hyperthyroidism was a more frequent (9.6%) complication of amiodarone therapy in West Tuscany, where iodine intake is moderately low; hypothyroidism was more frequent (22%) in Worcester, where iodine intake is sufficient. In patients receiving chronic amiodarone therapy, clinically suspected hyperthyroidism is best confirmed by showing elevations in serum T3 or free T3 concentrations; hypothyroidism is best diagnosed by showing an elevated serum thyrotrophin concentration. Thyroid function should be carefully monitored in patients receiving amiodarone chronically, especially if they have goiter or Hashimoto's thyroiditis.
胺碘酮是一种常用于治疗心律失常和心绞痛的含碘药物，对甲状腺激素代谢有多种影响，包括减少三碘甲状腺原氨酸（T3）的生成以及降低甲状腺素和反式T3的清除率。这些影响导致血清甲状腺素和反式T3浓度升高，血清T3浓度降低。此外，长期接受胺碘酮治疗的患者可能会发生碘致甲状腺功能亢进或减退。本研究是对意大利托斯卡纳西部的卢卡和比萨以及美国马萨诸塞州伍斯特甲状腺功能障碍发生率的回顾性分析。在碘摄入量适度偏低的托斯卡纳西部，甲状腺功能亢进是胺碘酮治疗更常见（9.6%）的并发症；在碘摄入量充足的伍斯特，甲状腺功能减退更常见（22%）。在接受胺碘酮长期治疗的患者中，临床疑似甲状腺功能亢进最好通过血清T3或游离T3浓度升高来确诊；甲状腺功能减退最好通过血清促甲状腺激素浓度升高来诊断。长期接受胺碘酮治疗的患者应仔细监测甲状腺功能，尤其是如果他们有甲状腺肿或桥本甲状腺炎。
