Feigl D, Gilad R, Tuwal M, Nakash I, Katz E
Dept. of Medicine D, Edith Wolfson Medical Center, Holon.
Harefuah. 1994 May 15;126(10):580-1, 627.
Thyroid function was examined periodically in a group of 85 patients treated with low-dose amiodarone, and followed for 1-13 years (mean 3.6). Biochemical hypothyroidism (elevated thyroid stimulating hormone (TSH) only) developed in 8 patients and clinical hypothyroidism in 3, while hypothyroidism developed in 5. In the first 11 cases amiodarone was continued but 1-thyroxine was added. In the 5 that became hyperthyroid, amiodarone was stopped and thyroid function became normal within a few months. In the 69 patients without thyroid dysfunction, elevated thyroxine (T4) and free thyroxine index (FTI) were found in 20% and 17%, respectively, and elevated free T4 (FT4) in 28%; all had normal total tri-iodothyronine (TT3) and TSH. In practically all patients, reverse T3 (rT3) rose more than 30% above initial levels. It is concluded that in patients treated with low dose amiodarone: 1) thyroid function should be followed closely; 2) elevated levels of TT4, FTI and FT4 do not necessarily imply hyperthyroidism; 3) hypothyroidism may be biochemical only, without progression to overt hypothyroidism, despite continued treatment; 4) both the hypo- and the hyperthyroidism induced are usually reversible; 5) amiodarone may be continued despite onset of hypothyroidism, provided replacement therapy is given.
对一组接受低剂量胺碘酮治疗的85例患者定期进行甲状腺功能检查，并随访1至13年（平均3.6年）。8例患者出现生化性甲状腺功能减退（仅促甲状腺激素（TSH）升高），3例出现临床甲状腺功能减退，5例出现甲状腺功能亢进。前11例患者继续服用胺碘酮，但加用了左甲状腺素。在5例出现甲状腺功能亢进的患者中，停用胺碘酮后甲状腺功能在几个月内恢复正常。在69例无甲状腺功能障碍的患者中，分别有20%和17%的患者甲状腺素（T4）和游离甲状腺素指数（FTI）升高，28%的患者游离T4（FT4）升高；所有患者总三碘甲状腺原氨酸（TT3）和TSH均正常。几乎所有患者的反三碘甲状腺原氨酸（rT3）均比初始水平升高超过30%。得出结论：在接受低剂量胺碘酮治疗的患者中：1）应密切随访甲状腺功能；2）TT4、FTI和FT4水平升高不一定意味着甲状腺功能亢进；3）甲状腺功能减退可能仅为生化性，尽管继续治疗也不会进展为明显的甲状腺功能减退；4）所诱发的甲状腺功能减退和甲状腺功能亢进通常都是可逆的；5）尽管出现甲状腺功能减退，但只要给予替代治疗，胺碘酮仍可继续使用。
