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碘过量与医源性甲状腺疾病(作者译)

[Iodine excess and iatrogenic thyroid pathology (author's transl)].

作者信息

Leger A F, Laurent M F, Savoie J C

出版信息

Ann Endocrinol (Paris). 1981 Oct-Nov;42(4-5):446-53.

PMID:7340698
Abstract

Iodine-induced thyroid disorder is frequent. Amiodarone is responsible for more than half cases of iodine-induced hypothyroidism and hyperthyroidism. Iodine-induced hypothyroidism is detected by the Perchlorate discharge test where its positivity suggests failure of the normal iodine organification. An inhibition of the thyroglobulin proteolysis is probably involved in the pathological process of iodine-induced hypothyroidism. Premature infants are unusually sensitive to iodine excess. Hypothyroidism has been induced in 50% of newborns of 34 weeks or less of gestation after the application, for a few days, of iodized antiseptics. Iodine-induced thyrotoxicosis account for 6% of patients with hyperthyroidism. It occurs most frequently in male with prior normal thyroid gland. The main diagnosis features are the activation of the 131I uptake by exogenous TSH and the spontaneous evolution towards cure. However, in some cases, the severity of the thyrotoxicosis or the slow spontaneous resolution require surgical or medical therapy. From different therapeutic trials it seems that only corticoids and Propylthiouracile are useful. PTU, believed as the drug of choice, has however an incomplete and inconstant effect. The histochemical aspects of the iodine-induced hypo and hyperthyroidism let suppose the possibility of some common mechanism.

摘要

碘诱导的甲状腺疾病很常见。胺碘酮导致了超过半数的碘诱导的甲状腺功能减退症和甲状腺功能亢进症病例。碘诱导的甲状腺功能减退症通过过氯酸盐释放试验检测,该试验呈阳性表明正常碘有机化失败。甲状腺球蛋白蛋白水解的抑制可能参与了碘诱导的甲状腺功能减退症的病理过程。早产儿对碘过量异常敏感。在应用含碘防腐剂几天后,妊娠34周或更短的新生儿中有50%发生了甲状腺功能减退症。碘诱导的甲状腺毒症占甲状腺功能亢进症患者的6%。它最常发生在甲状腺先前正常的男性中。主要诊断特征是外源性促甲状腺激素激活131I摄取以及自发好转。然而,在某些情况下,甲状腺毒症的严重程度或自发缓解缓慢需要手术或药物治疗。从不同的治疗试验来看,似乎只有皮质类固醇和丙硫氧嘧啶有用。丙硫氧嘧啶被认为是首选药物,但其效果不完全且不稳定。碘诱导的甲状腺功能减退症和甲状腺功能亢进症的组织化学方面提示可能存在一些共同机制。

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