Samaras K, Marel G M
Department of Endocrinology, Concord Repatriation General Hospital, N.S.W., Australia.
Clin Endocrinol (Oxf). 1996 Sep;45(3):365-8. doi: 10.1046/j.1365-2265.1996.00566.x.
We report a case of amiodarone-induced thyrotoxicosis of protracted duration, unresponsive to conventional thionamide therapy, with therapy limited by severe adverse drug reactions. Other treatment modalities included high dose corticosteroids, plasmapheresis, lithium and perchlorate. Temporary amelioration was achieved following plasmapheresis; however, this and other measures were unsuccessful in controlling the thyrotoxicosis, which deteriorated to thyroid storm. Histopathologically, a degenerative, inflammatory thyroiditis was evident. We discuss the limitations of conventional drug therapy and the lack of a sustained response to plasmapheresis. The failure of high doses steroids to alter the course of illness and to completely suppress the thyroidal inflammatory process is highlighted. A potential role for renal and hepatic impairment in the observed protracted course of amiodarone-induced thyrotoxicosis is suggested.
我们报告一例胺碘酮所致的持续性甲状腺毒症病例，该病例对传统硫酰胺类药物治疗无反应，且因严重药物不良反应而限制了治疗。其他治疗方式包括高剂量皮质类固醇、血浆置换、锂盐和高氯酸盐。血浆置换后病情暂时改善；然而，这一措施及其他措施均未能成功控制甲状腺毒症，病情恶化为甲状腺危象。组织病理学检查显示为退行性、炎症性甲状腺炎。我们讨论了传统药物治疗的局限性以及血浆置换缺乏持续疗效的问题。强调了高剂量类固醇未能改变疾病进程并完全抑制甲状腺炎症过程。提示肾和肝功能损害在胺碘酮所致甲状腺毒症的迁延病程中可能起一定作用。
