PDF(Pubmed)
Abstract：
Amiodarone is a class III anti-arrhythmic drug found to be effective in treating multiple life-threatening arrhythmias, including paroxysmal atrial fibrillation. Despite its effectiveness, amiodarone has been found to result in thyroid dysfunction. Amiodarone-induced thyrotoxicosis (AIT) is classified as type 1, which often develops in those with autoimmune hyperthyroid conditions, or type 2, which occurs because of destructive thyroiditis in an apparently normal thyroid. Differentiating between both types often poses a clinical and therapeutic dilemma, as AIT 1 is treated with thionamides, whereas AIT 2 requires steroids for treatment. We present a case of a patient with AIT who was treated empirically for both subtypes with methimazole and prednisone without clinical improvement. Methimazole was later stopped due to concern for agranulocytosis, and the patient was then treated with cholestyramine, metoprolol, and prednisone. Given persistent thyrotoxicosis, the decision was made to proceed with surgical intervention. The patient underwent a successful total thyroidectomy without complications. The patient\'s condition clinically improved post-surgery and was discharged home on post-operative day 2 in stable condition. Prednisone was tapered over two weeks, and he was started on a weight-based dose of levothyroxine. He continues to follow up in our clinic for postoperative hypothyroidism and is clinically and biochemically euthyroid.
摘要：
胺碘酮是一种III类抗心律失常药物，可有效治疗多种危及生命的心律失常，包括阵发性心房颤动.尽管有效,已发现胺碘酮会导致甲状腺功能障碍。胺碘酮诱导的甲状腺毒症（AIT）被归类为1型，通常在患有自身免疫性甲状腺功能亢进的患者中发展。或2型，其发生是由于在明显正常的甲状腺中的破坏性甲状腺炎。区分这两种类型通常会带来临床和治疗上的困境，由于AIT1用硫代酰胺处理，而AIT2需要类固醇治疗。我们介绍了一例AIT患者的病例，该患者接受了甲咪唑和泼尼松两种亚型的经验性治疗，但没有临床改善。后来由于担心粒细胞缺乏症而停用了甲氧咪唑，然后患者接受了消胆胺治疗，美托洛尔,和泼尼松。鉴于持续性甲状腺毒症，决定进行手术干预.患者接受了成功的全甲状腺切除术，无并发症。患者的病情在术后临床上有所改善，并在术后第2天出院，病情稳定。泼尼松在两周内逐渐变细，他开始服用以体重为基础的左甲状腺素。他继续在我们的诊所进行术后甲状腺功能减退症的随访，并且在临床和生化上甲状腺功能正常。
