Painvin I, Dupuis J M, Victor J, Rohmer V, Ronceray J, Tadéi A
Service de cardiologie, CHRU d'Angers.
Arch Mal Coeur Vaiss. 1996 Apr;89(4):445-9.
Amiodarone-induced hyperthyroidism in a relatively rare complication of long-term treatment with this molecule. It usually carries a good prognosis with regression being the rule after withdrawal of the drug although lethal forms have been reported. Conventional medical therapy (synthetic antithyroid drugs, steroids, betablockers) used in severe forms, is not always effective. In addition, amiodarone may be essential for the treatment of life-threatening, poorly tolerated arrhythmias, refractory to other forms of treatment. The authors report the cases of three patients treated with amiodarone for malignant arrhythmias who developed severe hyperthyroidism resistant to medical therapy and who were treated by total thyroidectomy. Surgery was followed by rapid resolution of the thyrotoxicosis without significant complications and immediate represcription of amiodarone. Thyroidectomy therefore seems a simple solution for amiodarone-induced hyperthyroidism allowing very rapid resolution of the hyperthyroidism and the possibility of immediate represcription of amiodarone.
胺碘酮所致甲状腺功能亢进是长期使用该药物相对罕见的并发症。尽管有致死病例的报道,但通常预后良好,停药后甲状腺功能亢进一般会消退。对于严重的胺碘酮所致甲状腺功能亢进,常规药物治疗(合成抗甲状腺药物、类固醇、β受体阻滞剂)并不总是有效。此外,胺碘酮对于治疗危及生命、耐受性差且对其他治疗无效的心律失常可能必不可少。作者报告了3例因恶性心律失常接受胺碘酮治疗后发生严重药物治疗抵抗性甲状腺功能亢进并接受甲状腺全切除术的患者。手术后甲状腺毒症迅速缓解,无明显并发症,且可立即重新使用胺碘酮。因此,甲状腺切除术似乎是治疗胺碘酮所致甲状腺功能亢进的一个简单解决方案,能使甲状腺功能亢进迅速缓解,并可立即重新使用胺碘酮。