Treatment of Amiodarone-Induced Thyrotoxicosis Type 2: A Randomized Clinical Trial
Treatment of Amiodarone-Induced Thyrotoxicosis Type 2: A Randomized Clinical Trial
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DOI：
10.1210/jc.2011-2390
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发表时间：
2012-02-01
影响因子：
5.8
通讯作者：
Wiersinga, Wilmar M.
中科院分区：
文献类型：
--
作者：
Eskes, Silvia A.;Endert, Erik;Wiersinga, Wilmar M.
背景：胺碘酮诱导的2型甲状腺毒症（AIT）本质上是自限性的，但大多数医生不愿继续使用胺碘酮。当强的松不能恢复甲亢时，可能是由于AIT 1型和2型的混合病例，高氯酸盐（ClO4）可能是有用的，因为ClO4可以降低胺碘酮对甲状腺细胞的细胞毒性作用。目的：我们的目的是证明胺碘酮在2型AIT中继续使用的可行性，并评估ClO4（单独或与强的松联合使用）在2型AIT中的有效性。设计和环境：在荷兰10家医院进行了一项随机多中心研究。方法：2型AIT患者随机接受强的松30 mg/d （A组，n = 12）、高氯酸钠500 mg每日2次（B组，n = 14）或强的松加高氯酸盐（C组，n = 10）治疗；所有患者均继续使用胺碘酮，并同时使用甲巯咪唑30mg /d。随访2年。主要观察指标：观察治疗效果（以继续使用胺碘酮时TSH值>= 0.4 mU/l为标准）和甲状腺毒症复发情况。结果：A、B、C组患者初治有效率分别为100%、71%、100% （P = 0.03）。B组29%患者经强的松治疗后甲状腺功能恢复正常。达到TSH为0.4 mU/l或更高的时间[A、B、C组分别为8周（4-20）、14周（4-32）和12周（4-28）]和达到游离T-4为25 pmol/l或以下的时间[A、B、C组为4周（4-20）、12周（4-20）和8周（4-20）]在组间均无显著差异（数值为中位数，有范围）。复发性甲状腺毒症发生率为8.3%。结论：所有患者在继续使用胺碘酮的情况下均达到甲状腺功能亢进。强的松仍然是2型AIT的首选治疗方式，因为单独使用高氯酸盐或与强的松联合使用没有更好的结果。[J] .中华内分泌杂志，2012,27(5):387 - 398。
Context: Amiodarone-induced thyrotoxicosis (AIT) type 2 is self-limiting in nature, but most physicians are reluctant to continue amiodarone. When prednisone fails to restore euthyroidism, possibly due to mixed cases of AIT type 1 and 2, perchlorate (ClO4) might be useful because ClO4 reduces the cytotoxic effect of amiodarone on thyrocytes.Objectives: Our objectives were to demonstrate the feasibility of continuation of amiodarone in AIT type 2 and to evaluate the usefulness of ClO4 (given alone or in combination with prednisone) in AIT type 2.Design and Setting: A randomized multicenter study was conducted in 10 Dutch hospitals.Methods: Patients with AIT type 2 were randomized to receive prednisone 30 mg/d (group A, n = 12), sodium perchlorate 500 mg twice daily (group B, n = 14), or prednisone plus perchlorate (group C, n = 10); all patients continued amiodarone and were also treated with methimazole 30 mg/d. Follow-up was 2 yr.Main Outcome Measures: Treatment efficacy (defined as TSH values >= 0.4 mU/liter under continuation of amiodarone) and recurrent thyrotoxicosis were evaluated.Results: Initial therapy was efficacious in 100, 71, and 100% of groups A, B, and C, respectively (P = 0.03). The 29% failures in group B became euthyroid after addition of prednisone. Neither the time to reach TSH of 0.4 mU/liter or higher [8 wk (4-20), 14 wk (4-32), and 12 wk (4-28) in groups A, B, and C respectively] nor the time to reach free T-4 of 25 pmol/liter or below [4 wk (4-20), 12 wk (4-20), and 8 wk (4-20) in groups A, B, and C) were significantly different between groups (values as median with range). Recurrent thyrotoxicosis occurred in 8.3%.Conclusion: Euthyroidism was reached despite continuation of amiodarone in all patients. Prednisone remains the preferred treatment modality of AIT type 2, because perchlorate given alone or in combination with prednisone had no better outcomes. (J Clin Endocrinol Metab 97:499-506, 2012)