口服胺碘酮致甲状腺功能异常的临床观察

Adverse Drug Reactions from Oral Amiodarone on Thyroid Function

目的探讨口服胺碘酮对心律失常患者甲状腺功能的影响。方法选取心律失常患者97例,给予口服胺碘酮,第1周200 mg,3次/日;第2周200 mg,2次/日;3周后200 mg,1次/日维持。分别在用药前、用药后7、30、90、180、360天测患者血清甲状腺激素水平。结果共计94例患者完成实验,服用胺碘酮后第7天时,TT3、FT3较治疗前下降,第30天至第90天时,降到最低,与治疗前比较,差异有统计学意义(P<0.05)。TSH在服用胺碘酮后第7天时上升,第30天时达高峰,与治疗前比较,差异有统计学意义(P<0.05)。TT4、FT4于服用胺碘酮第7天时上升,第90天至第180天时达高峰,与治疗前比较,差异有统计学意义(P<0.05)。发生甲状腺功能异常者共22例,占完成实验患者总数的23.4%,其中甲状腺功能减低者20例,甲状腺功能亢进者2例,给予相应处理后,甲状腺激素水平均恢复正常。结论心律失常患者服用胺碘酮,甲状腺激素水平变化显著,甲状腺功能异常者发生率较高,所以用药过程中应定期监测患者甲状腺激素水平的变化,发现异常,及时处理,一般预后良好。

Objective To study the effects of oral amiodarone on thyroid function. Methods 97 patients with cardiac arrhythmias were treated with a loading dose of amiodarone （600 mg/d ） for 1 week and then given with a dose of 400 mg/d for the second week and then with a maintaining dose of 200 mg daily. The serum thyroid hormone levels were detected with radioimmunoassay. Results The serum free and total T3 levels were found to decrease progressively from the 7 th day and significantly at the 1st to 3 rd month. TSH, free and total T4 levels were found to increase at the early stage. The increments reached the peak values at the 1st month for TSH and between the 3rd and 6 th month for free and total T4. 22 cases were found to have abnormal changes in thyroid hormones throughout the study. However, some patients could recover spontaneously but gradually without any therapy, except 9 cases with obvious symptoms. Conclusion The low oral dose of aminod- arone can change the levels of thyroid hormones of the patients with cardiac arrhythmias. However, it recover spontaneously but gradually in most of the cases. Therefore, oral low dose amiodarone is safe for the patients, but they must be monitored closely.