Amiodarone 引發㆙狀腺毒症 - tsim.org.tw

1 1 Amiodarone amphetamine antihemophilic factor VIII imipramine lithium aminodarone glucocorticoid dopamine Amiodarone Amiodarone benzofuranic Class-III triiodothyronine 28~107 Amiodarone Amiodarone (1~23%) (1~32%) Amiodarone , Amiodarone thionamide KClO4 propranolol Amiodarone Amiodarone induced Amiodarone induced Amiodarone induced Amiodarone induced Thyrotoxicosis , AITT hyrotoxicosis , AITT hyrotoxicosis , AITT hyrotoxicosis , AIT 2.

2 2. 2. 2. iodineiodineiodineiodine 3. 3. 3. 3. ventricular fibrillationventricular fibrillationventricular fibrillationventricular fibrillation 4. 4. 4. 4. ThyroidectomyThyroidectomyThyroidectomyT hyroidectomy DNA mRNA ribosomal RNA amphetamine T3 T4 FT4I 1 antihemophilic factor VIII T4 2 imipramine T4 120 ST-T 3 2dopamine4-8, octreotide9,10, lithium11 ( 1.) glucocorticoid12,13 propranolol14 lithium Amiodarone Amiodarone Amiodarone -induced Thyrotoxicosis AIT Amiodarone Amiodarone benzofuranic Class-III triiodothyronine Amiodarone 42% 96% ~12 L/Kg 28~107 Amiodarone Amiodarone (AIT,1~23%) (1~32%)15 100mg Amiodarone Amiodarone 200mg~600mg/day 75~225mg WHO ~ 16,17 goiter (Wolff-Chaikoff) 3.

3 Subacute thyroiditis (Jod-Basedow effect) 18,19 Amiodarone iodothyronine 5'-deiodinase 5'-monodeiodination T4 T3 T4 r T3 (reverse T3) T3 Amiodarone T4-T3 TSH TSH AIT Amiodarone Amiodarone 20-22 Amiodarone Amiodarone AIT 84% 1~14 16% AIT AIT AIT Amiodarone 50% AIT Amiodarone TT4 FT4 FT4I FT3 & rT3 TT3 FT3I Amiodarone AIT TT3 FT3I Amiodarone (30 ) 55% 23,24 AIT ( 2.) Amiodarone Amiodarone AIT 3 Amiodarone Amiodarone FT4 TSH Amiodarone 30 T4 T3 AITAITAITAIT Amiodarone Amiodarone AIT( ) Amiodarone AIT , Amiodarone 8 25 Thionamides MTZ(methimazole) PTU(propylthiouracil)

4 AIT Isidro Bartalena 26,27 AIT Typ e I- Graves'disease Type II- Typ e II AIT glucocorticoids Type I AIT MTZ KClO4 MTZ T4 T3 KClO4 KClO4 1000mg/day MTZ 40mg/day 15~45 15~90 KClO4 MTZ 6~55 KClO4 MTZ KClO4 MTZ AIT KClO4 fatal aplastic anemia agranulocytosis nephrotic syndrome leukopenia renal damage .. ( >1gm/day ) KClO4 1gm Graves' disease KClO4 28 Thionamides propranolol dexamethasone prednisolone 5'-deiodinase Thionamides AIT Dickstein 29, PTU300~600mg /day lithium( 300mg tid/day ~ ) AIT 4~5 AIT AIT, 30 Amiodarone AIT 4 AIT Amiodarone AIT AIT Amiodarone 6 AIT AIT TSH T4 FT4 T3 AIT thionamides corticosteroid propranolol lithium KClO4 Amiodarone 1.

5 (TSH) Dopamine Glucocorticoids Octreotide Lithium Iodide Amiodarone Aminoglutethimide Iodide Amiodarone (TBG) Estrogens Tamoxifen Heroin Methadone Mitotane Fluorouracil Androgens Anabolic steroids , danazol Slow-release nicotinic acid Glucocorticoids Furosemide Fenclofenac Mefenamic acid Salicylates 5 Phenobarbital Rifampin Phenytoin Carbamazepine T4 5' deiodinase Propylthiouracil Amiodarone Beta-adrenergic-antagonist drugs Glucocorticoids (Cytokines) Interferon alfa Interleukin-2 2.

6 AmiodaroneBeziodaroneCalcium iodideDiiodohydroxyquinEchothiophate iodide oph. solutionHydriodic acid syrupIndochlorhydroxyquinIodine-containi ng vitaminsIodinated glycerolIodinated expectorantsIodized lecithineIodopropylidene glycerolIodoxiuridone oph. solutionIodined eye dropsIsopropamide iodidePotassium iodideLugol s solutionSaturated Potassium iodide solution Sodium iodide(10%)solution Diiodohydroxyquin creamIodine tinctureIodoform gauzeIndochlorhydroxyquin creamPovidone iodineDiatrizoate meglumine and sodiumIodized oilIopanoic acidIpodateIothalamateMetrizamide6 8 Reference1. Morley JE et al: Amphetamine-induced hyperthyroxinemia. Ann Intern Med 1980; 93 Winter JSD & Smail PJ: Raised serum thyroxine in patient on haemophilia therapy (letter).Lancet 1980; 2 Colantonio LA & Orson JM: Triiodothyronine thyrotoxicosis: induction by desiccated thyroidand imipramine.

7 Am J Dis Child 1974; 128 Cooper DS, Klibanski A, Ridgway EC. Dopaminergic modulation of TSH and its subunits: invivo and in vitro studies. Clin Endocrinol (Oxf) 1983;18 T, Haagen C, Andersen AN, Djursing H, Increased dopaminergic activity inhibits basaland metoclopramide-stimulated prolactin and thyrotropin Clin Endocrinol Metab1986;62 S, Hagen C, Hangaard J, Andersen AN, Eldrup E, Effect od dopamine and a dopamineD-1 receptor agonist on pulsatile thyrotropin secretion in normal women. Clin Endocrinol (Oxf)1990;32 DJ, Singh VK, McConway MG,et al. Circadian variation of thyrotropin, determined byultrasensitive immunoradiometric assay, and the effect of low dose nocturnal dopamine Sci 1987;72 G, Prank K, Hoang-Vu C, Hesch RD, von zur Muhlen A. Hypothalamic regulation ofthyrotropin secretion . J Clin Endocrinol Metab 1991;72 J, Brue T, Enjalbert A,et al. Somatostadin receptors on thyrotropin-secreting pituitaryadenomas: comparison with the inhibitory effects of octreotide upon in vivo and in vitrohormone secretions.

8 J Clin Endocrinol Metab 1992;75 SE, Weeke J, Orskov H, et al. Long-term efficacy and tolerability of octreotidetreatment in acromegaly. Metabolism 1992;41: Suppl 2 CA & Chrousos GP: Transient elevation of serum thyroid hormone levels following lithium discontinuation. Eur J Pediatr 1996; 155 A, Brabant G, Schuermeyer T, et al. The role of glucocorticoids in the regulation ofthyrotropin. Acta Endocrinol 1989;121 MH, Luther M, Henry P, Ridgway EC, Effects of hydrocortisone on pulsatile pituitaryglycoprotein secretion. J Clin Endocrinol Metab 1994;78 OR, Melander A & Tegler L: Effects and plasma levels of propranolol andmetoprolol in hyperthyroid patients. Br J Clin Pharmacol 1980; 18 Information: Cordarone(R), Amiodarone . Wyeth-Ayerst Laboratories, Philadelphia, PA; RH, McCready VR & Spathis GS: Iodine kinetic studies during Amiodarone treatment. JClin Endocrinol Metab 1986; 62 D,Incidence,Predictability,and Pathogenesis of Amiodarone -Induced Thyrotoxicosis andHypothyroidism, The 1991; 91, J.

9 Harjai,Angelo A. Licata , Effects of Amiodarone on Thyroid Function,Ann InternMed. 1997; 126, Martino, Amiodarone :A common source of Iodine-Induced Thyrotoxicosis, Hormone ;26, LE. Iodine induced thyroid disease. Acta Med Austriaca 1990;17: Suppl 1 HL, Figge J. The effect of Amiodarone on thyroid hormon function : a review of thephysiology and clinical manifestations. J Clin Pharmacol 1990;30 FIR, Tres BW, Colman PG, Deam DR. Iodine-induced hyperthyroidism due to nonionicontrast radiography in the eldery. Am J Med 1993;95: Monteiro,A Galvao-Teles, Antithyroid antibodies as an early marker for thyroid diseaseinduced by Amiodarone , 1986;292, K, Yamazaki K, Dhnishi S, et al. Amiodarone induced thyrotoxicosis associated withthyrotropin receptor antibody. Thyroid. 1998; 8: KJ, Licata AA, Amiodarone induced hyperthyroidism: a case series and brief review ofliterature. Pacing & ClinicalElectrophysiology. 1996 Nov;19(11 pt 1), Bartalena L, Brogioni S, Grasso L et al: Treatment of Amiodarone - induced thyrotoxicosis , adifficult challenge: results of a prospective study.

10 J Clin Endocrinol Metab 1996; 81 Isidro ML: Amiodarone and thyroid function (letter). Ann Intern Med 1997; 127 ,Treatment of Amiodarone associated thyrotoxicosis by simultaneous administrationof potassium perchlorate and methimazole, Invest. 1986; 9, G, Shechner C, Adawi F et al: Lithium treatment in Amiodarone -induced J Med 1997; 102 E, Meurisse M, Defechereux T, et al. Surgical management of Amiodarone -associatedthyrotoxicosis: too risky or too effective ?.World J Surgery 1998;22:537-42;discussion 10 Amiodarone Induced ThyrotoxicosisDrugs that alter the results of thyroid function tests and the effect of treatment must always beconsidered in decision- making regarding p't care. Several drugs such as glucocorticoid , dopamine,octreotide, amphetamine, antihemophilic factor VIII, lithium, , were the drugs thatcan influence the thyroid function.