The effects of amiodarone on the thyroid.
The effects of amiodarone on the thyroid.
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胺碘酮对甲状腺的影响。
DOI：
10.1210/edrv.22.2.0427
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发表时间：
2001
影响因子：
20.3
通讯作者：
L. Braverman
中科院分区：
文献类型：
--
作者：
E. Martino;L. Bartalena;F. Bogazzi;L. Braverman
胺碘酮是一种苯并呋喃类富碘药物，广泛用于治疗快速性心律失常，并在较小程度上用于治疗缺血性心脏病。它经常引起甲状腺功能试验的改变(典型的是血清T(4)和RT(3)升高，血清T(3)浓度下降)，主要与抑制5‘-脱碘酶活性有关，导致T(4)生成T(3)的减少和RT(3)的清除减少。在接受胺碘酮治疗的患者中，有14-18%的患者存在明显的甲状腺功能障碍，要么是胺碘酮诱导的甲状腺毒症(AIT)，要么是胺碘酮诱导的甲状腺功能减退(AIH)。AIT和AIH都可能发生在表面上正常的甲状腺中，也可能发生在既有临床无症状异常的腺体中。先前存在的桥本甲状腺炎是AIH发生的一个明确的危险因素。碘诱导的AIH的发病机制与甲状腺激素生成缺陷而未能逃脱急性Wolff-Chaikoff效应有关，在甲状腺自身抗体试验阳性的患者中，与合并桥本甲状腺炎有关。AIT主要与异常甲状腺(I型AIT)中过量碘诱导的甲状腺激素合成有关，或与胺碘酮相关的破坏性甲状腺炎(II型AIT)有关，但混合形式经常存在。AIH的治疗包括L-T(4)替代治疗，同时继续胺碘酮治疗；或者，如果可行，可以停用胺碘酮，特别是在没有甲状腺异常的情况下，通过短疗程的高氯酸钾治疗可以加速甲状腺功能正常的自然进程。在I型AIT中，主要的药物治疗包括同时给予亚硫酰胺和高氯酸钾，而在II型AIT中，糖皮质激素是最有用的治疗选择。混合型最好用亚硫酰胺、高氯酸钾和糖皮质激素的组合治疗。由于甲状腺放射性碘摄取率低，放射性碘治疗通常是不可行的，而甲状腺切除术可以在对药物治疗无效的病例中进行，手术风险略有增加。
Amiodarone is a benzofuranic-derivative iodine-rich drug widely used for the treatment of tachyarrhythmias and, to a lesser extent, of ischemic heart disease. It often causes changes in thyroid function tests (typically an increase in serum T(4) and rT(3), and a decrease in serum T(3), concentrations), mainly related to the inhibition of 5'-deiodinase activity, resulting in a decrease in the generation of T(3) from T(4) and a decrease in the clearance of rT(3). In 14-18% of amiodarone-treated patients, there is overt thyroid dysfunction, either amiodarone-induced thyrotoxicosis (AIT) or amiodarone-induced hypothyroidism (AIH). Both AIT and AIH may develop either in apparently normal thyroid glands or in glands with preexisting, clinically silent abnormalities. Preexisting Hashimoto's thyroiditis is a definite risk factor for the occurrence of AIH. The pathogenesis of iodine-induced AIH is related to a failure to escape from the acute Wolff-Chaikoff effect due to defects in thyroid hormonogenesis, and, in patients with positive thyroid autoantibody tests, to concomitant Hashimoto's thyroiditis. AIT is primarily related to excess iodine-induced thyroid hormone synthesis in an abnormal thyroid gland (type I AIT) or to amiodarone-related destructive thyroiditis (type II AIT), but mixed forms frequently exist. Treatment of AIH consists of L-T(4) replacement while continuing amiodarone therapy; alternatively, if feasible, amiodarone can be discontinued, especially in the absence of thyroid abnormalities, and the natural course toward euthyroidism can be accelerated by a short course of potassium perchlorate treatment. In type I AIT the main medical treatment consists of the simultaneous administration of thionamides and potassium perchlorate, while in type II AIT, glucocorticoids are the most useful therapeutic option. Mixed forms are best treated with a combination of thionamides, potassium perchlorate, and glucocorticoids. Radioiodine therapy is usually not feasible due to the low thyroidal radioiodine uptake, while thyroidectomy can be performed in cases resistant to medical therapy, with a slightly increased surgical risk.
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影响因子：
56.9
作者：
BAGCHI, N;BROWN, TR;SUNDICK, RS
通讯作者：
SUNDICK, RS
胺碘酮体外细胞毒作用的研究。
影响因子：
4.8
作者：
Chiovato,L;Martino,E;Tonacchera,M;Santini,F;Lapi,P;Mammoli,C;Braverman,LE;Pinchera,A
通讯作者：
Pinchera,A
胺碘酮对促甲状腺素受体以及培养的狗甲状腺细胞中促甲状腺素和卡巴胆碱刺激的反应有影响。
影响因子：
4.8
作者：
Rani,CS
通讯作者：
Rani,CS
甲状腺功能正常且既往患有胺碘酮诱发的甲状腺毒症的受试者中，碘诱发的亚临床甲状腺功能减退症。
DOI：
10.1210/jcem.75.5.1331165
发表时间：
1992
期刊：
The Journal of clinical endocrinology and metabolism
影响因子：
--
作者：
Roti,E;Minelli,R;Gardini,E;Bianconi,L;Gavaruzzi,G;Ugolotti,G;Neri,TM;Braverman,LE
通讯作者：
Braverman,LE
接受左甲状腺素治疗原发性甲状腺功能减退症的患者中胺碘酮诱导促甲状腺激素升高。
影响因子：
39.2
作者：
Figge,J;Dluhy,RG
通讯作者：
Dluhy,RG