Amiodarone and the thyroid: A 2012 update

被引:88
作者
Bogazzi, F. [1 ]
Tomisti, L. [1 ]
Bartalena, L. [2 ]
Aghini-Lombardi, F. [1 ]
Martino, E. [1 ]
机构
[1] Univ Pisa, Dept Endocrinol & Metab, I-56124 Pisa, Italy
[2] Univ Insubria, Dept Clin & Expt Med, Varese, Italy
关键词
Amiodarone; amiodarone-induced hypothyroidism; amiodarone-induced thyrotoxicosis; hyperthyroidism; iodine; thyroid; FLOW DOPPLER SONOGRAPHY; IODINE-INDEPENDENT MECHANISM; INDUCED THYROTOXICOSIS; INDUCED HYPOTHYROIDISM; IOPANOIC ACID; IN-VITRO; POTASSIUM PERCHLORATE; RADIOACTIVE IODINE; DIFFERENTIAL-DIAGNOSIS; ANTITHYROID ANTIBODIES;
D O I
10.3275/8298
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Amiodarone-induced thyroid dysfunction occurs in 15-20% of amiodarone-treated patients. Amiodarone-induced hypothyroidism (AIH) does not pose relevant problems, is easily controlled by L-thyroxine replacement, and does not require amiodarone withdrawal. Most frequently AIH develops in patients with chronic autoimmune thyroiditis. Amiodarone-induced thyrotoxicosis (All) is most frequently due to destructive thyroiditis (type 2 All) causing discharge of thyroid hormones from the damaged, but otherwise substantially normal gland. Less frequently AIT is a form of hyperthyroidism (type 1 AIT) caused by the iodine load in a diseased gland (nodular goiter, Graves' disease). A clearcut differentiation between the two main forms is not always possible, despite recent diagnostic advances. As a matter of fact, mixed or indefinite forms do exist, contributed to by both thyroid damage and increased thyroid hormone synthesis. Treatment of type 1 (and mixed forms) AIT is based on the use of thionamides, a short course of potassium perchlorate and, if treatment is not rapidly effective, oral glucocorticoids. Glucocorticoids are the first-line treatment for type 2 AIT. Amiodarone should be discontinued, if feasible from a cardiac standpoint. Continuation of amiodarone has recently been associated with a delayed restoration of euthyroidism and a higher chance of recurrence after glucocorticoid withdrawal. Whether amiodarone treatment can be safely reinstituted after restoration of euthyroidism is still unknown. In rare cases of AIT resistance to standard treatments, or when a rapid restoration of euthyroidism is advisable, total thyroidectomy represents a valid alternative. Radioiodine treatment is usually not feasible due to the low thyroidal iodine uptake. (J. Endocrinol. Invest. 35: 340-348, 2012) (C)2012, Editrice Kurtis
引用
收藏
页码:340 / 348
页数:9
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