Meurisse M, Hamoir E, D'Silva M, Joris J, Hennen G
Department of Endocrine Surgery, Centre Hospitalier Universitaire, Domaine du Sart-Tilman, Liege, Belgium.
World J Surg. 1993 Sep-Oct;17(5):622-6; discussion 627. doi: 10.1007/BF01659125.
Amiodarone-induced hyperthyroidism has on most instances been reported as mild, and thyroid functions return to normal after discontinuation of the drug. Nevertheless, life-threatening amiodarone-induced thyrotoxicosis has also been described. Conventional treatments such as antithyroid drugs (thionamide) and corticosteroids are essentially ineffective or fail to alter the dramatic course of the thyroid crisis. This limited effectiveness of medical therapy, particularly in patients with previously neglected or unknown thyroid disease, prompted us to intervene surgically. We report a series of nine patients who underwent total or near-total thyroidectomy as a first-line therapy for five of them. Surgery resulted in rapid resolution of thyrotoxicosis with an uneventful postoperative course. This approach has the advantage of immediate effectivity, low risk of relapse, and appears to be the only treatment that permits continued therapy with amiodarone when the drug appears needed to control a life-threatening arrhythmia.
胺碘酮所致甲状腺功能亢进在大多数情况下被报道为轻度，停药后甲状腺功能可恢复正常。然而，也有危及生命的胺碘酮所致甲状腺毒症的描述。传统治疗方法如抗甲状腺药物（硫酰胺类）和皮质类固醇基本上无效或无法改变甲状腺危象的严重病程。这种药物治疗效果有限，尤其是在既往被忽视或未知甲状腺疾病的患者中，促使我们进行手术干预。我们报告了一组9例患者，其中5例接受了甲状腺全切除术或近全切除术作为一线治疗。手术迅速缓解了甲状腺毒症，术后过程平稳。这种方法具有立即起效、复发风险低的优点，并且当似乎需要使用胺碘酮控制危及生命的心律失常时，这似乎是唯一允许继续使用胺碘酮治疗的方法。
