Current Opinion in Endocrinology, Diabetes and Obesity ( IF 3.2 ) Pub Date : 2020-10-01 , DOI: 10.1097/med.0000000000000562 Poorani N. Goundan , Stephanie L. Lee
Purpose of review
Amiodarone-induced thyroid dysfunction is well established and commonly encountered but is associated with several diagnostic and management challenges. The present review discusses recent evidence published related to the effects of amiodarone on the thyroid gland and thyroid function.
Recent findings
Retrospective studies to evaluate amiodarone-induced thyroid dysfunction in children show the occurrence of potential clinically significant changes within 2 weeks of amiodarone initiation that may not be detected if standard adult guidelines for thyroid hormone monitoring are followed. A small study evaluating beta-glucuronidase activity in amiodarone-induced thyrotoxicosis (AIT) demonstrated higher levels in patients with AIT type 2 compared to type 1. New data have suggested the incidence of agranulocytosis may be higher in patients on thionamides with AIT compared to hyperthyroidism because of other causes. In a small study, investigators demonstrated the use of a combination of intravenous and oral steroids to treat refractory AIT which needs to be evaluated in further controlled trials. Finally, recent data demonstrated a possible mortality benefit of surgery over medical therapy for AIT in patients with moderate to severe reduction in left ventricular ejection fraction.
Summary
Recent research regarding the prevalence, diagnosis, and management of amiodarone-induced thyroid dysfunction were reviewed.
中文翻译:
胺碘酮的甲状腺作用:临床更新
审查目的
胺碘酮引起的甲状腺功能障碍是公认的并且经常遇到,但与一些诊断和管理挑战相关。本文综述了最近发表的有关胺碘酮对甲状腺和甲状腺功能影响的证据。
最近的发现
评估儿童胺碘酮引起的甲状腺功能障碍的回顾性研究表明,胺碘酮启动后2周内发生了潜在的临床显着变化,如果遵循标准的成人甲状腺激素监测指南,可能无法检测到。一项评估胺碘酮引起的甲状腺毒症(AIT)中β-葡萄糖醛酸苷酶活性的小型研究表明,与1型相比,AIT 2型患者的血红细胞增多症发生率可能高于甲状腺功能亢进症患者。由于其他原因。在一项小型研究中,研究人员证明了静脉内和口服类固醇联合使用可治疗难治性AIT,需要在进一步的对照试验中进行评估。最后,最近的数据表明,对于左心室射血分数中度至重度降低的患者,手术对AIT可能比药物治疗具有更高的死亡率。
概要
综述了胺碘酮引起的甲状腺功能障碍的流行,诊断和治疗的最新研究。