What Is Amiodarone-derived Thyrotoxicosis
What is amiodarone-derived thyrotoxicosis?
Amiodarone is an antiarrhythmic drug containing iodine, which is a source of synthetic thyroid hormones.
After patients use amiodarone, the synthesis of thyroid hormone can be increased due to the increased supply of "raw materials". Iodine may also directly destroy thyroid cells, resulting in the release of thyroid hormone stored therein into the blood at once. All these can cause continuous exposure of blood circulation and body tissues to elevated and excessive thyroid hormone, with certain toxic effects.
The patient presented with various symptoms such as palpitation, hand shaking, frequent eating and starvation, and weight loss, which was called amiodarone-derived thyrotoxicosis.
Amiodarone needs to be stopped after the occurrence of this disease, and other drugs for arrhythmia can be used under the guidance of cardiovascular physicians. In addition, medication such as methimazole and glucocorticoid is also needed.
What are the types of amiodarone-derived thyrotoxicosis?
The disease is generally divided into two types:
One is caused by the increased synthesis of thyroid hormone promoted by amiodarone, which is called type I amiodarone-derived thyrotoxicosis;
The other is caused by the direct destruction of thyroid cells by amiodarone, resulting in the release of thyroid hormone stored in it into the blood at once, which is called type II amiodarone-derived thyrotoxicosis.
Some patients may have both types of thyrotoxicosis.
What Is The Cause Of Amiodarone-derived Thyrotoxicosis
What causes amiodarone-derived thyrotoxicosis?
It is caused by the use of amiodarone.
Is amiodarone necessarily associated with amiodarone-derived thyrotoxicosis?
Not always. Thyrotoxicosis is related to other thyroid diseases and iodine intake in food.
People with family history of thyroid disease, iodine deficiency, goiter, thyroid peroxidase antibody positive, functional autonomous high-function thyroid adenoma, and past history of hyperthyroidism but normal thyroid function were more likely to suffer from thyrotoxicosis after taking amiodarone.
Will amiodarone-derived thyrotoxicosis be inherited?
What Symptom Does Amiodarone Source Sex Thyroid Poison Disease Have
What are the findings of amiodarone-derived thyrotoxicosis?
This disease common flustered, hand shaking, weight loss, irritability and other symptoms, but also lead to the original arrhythmia, heart failure aggravated.
What are the adverse consequences of amiodarone-derived thyrotoxicosis?
In patients already suffering from heart failure, the disease may increase mortality.
Some patients with type II amiodarone-derived thyrotoxicosis may develop permanent hypothyroidism at a later stage due to severe damage to thyroid cells, requiring lifelong thyroid hormone replacement therapy.
How To Check For Amiodarone-derived Thyrotoxicosis
What tests are needed to confirm a suspected amiodarone-derived thyrotoxicosis?
Thyroid function: used to diagnose the presence and severity of thyrotoxicosis.
Thyroid autoantibodies: These include thyroid peroxidase antibody TPOAb, thyroglobulin antibody TgAb, and thyrotropin receptor antibody TRAb, and are used to assist in the diagnosis of the etiology, as well as the presence of autoimmune thyroiditis and Graves' disease.
Thyroid ultrasound or radionuclide imaging: It is used to assist in the diagnosis of the etiology, and the type can be further assessed if the disease is present.
Do thyroid function check amiodarone source sex thyroid poison disease, what precautions?
Do thyroid function and autoantibody examination need to draw blood, not fasting, after eating can also be checked.
What are the precautions in doing thyroid radionuclide imaging for amiodarone-derived thyrotoxicosis?
Before thyroid radionuclide imaging, iodine-containing drugs, food and thyroid-related drugs cannot be taken for at least 1 week: iodine-containing drugs such as compound iodine solution, iodine-containing tablets and iodine-containing contrast agent; Iodine-containing Chinese medicinal such as seaweed, thallus laminariae, etc.; Thyroid-related drugs such as levothyroxine tablets, methimazole and propylthiouracil; Iodine-containing food such as kelp, laver, marine fish, jellyfish, sea rice, shrimp, etc.
This test is not recommended for pregnant and lactating women. If this examination is mandatory for nursing patients, breastfeeding should be stopped for at least 48 hours after the examination.
All inspectors should drink more water and urinate more after the examination. Stay in a fixed place of residence on the day of the examination and avoid close contact with others, especially children and pregnant women.
Amiodarone-derived thyrotoxicosis is easily confused with which diseases?
Autoimmune thyroiditis, Graves's disease, subacute thyroiditis, etc. can also cause thyrotoxicosis, which needs to be distinguished from this disease. The doctor can identify the disease by asking the medical history together with the above examinations.
How To Prevent Amiodarone-derived Thyrotoxicosis
Is amiodarone-derived thyrotoxicosis preventable?
While complete prevention is not possible, it can be avoided to the best of your ability by:
Before using amiodarone, check the thyroid function first, if there is hyperthyroidism, nodular goiter, should try not to use amiodarone, in order to avoid amiodarone derived thyrotoxicosis;
Thyroid function is also checked for the first 3 months after initiation of amiodarone therapy, and every 3–6 months thereafter, with early detection of thyroid dysfunction.
How To Treat Amiodarone-derived Thyrotoxicosis
Which branch should amiodarone source sex thyroid poison disease see?
Department of endocrinology, thyroid and breast surgery, general surgery.
How does amiodarone source sex thyroid poison disease treat?
Amiodarone is an important drug for the treatment of arrhythmia. If the patient must use amiodarone due to life-threatening arrhythmia and it is effective, amiodarone treatment can be continued after the occurrence of this disease. If the patient's arrhythmia is not life-threatening, we need to stop using amiodarone after the occurrence of this disease, and we can switch to other drugs for arrhythmia under the guidance of cardiovascular physicians.
Amiodarone was discontinued or not, methimazole was the first choice for type I amiodarone-derived thyrotoxicosis, and radioactive 131I therapy or surgical thyroidectomy could be considered when the treatment was ineffective or relapsed. Glucocorticoid treatment is the first choice for type Ⅱ amiodarone-derived thyrotoxicosis.
Doctors may also recommend a combination of methimazole and glucocorticoids if:
Either methimazole or glucocorticoid is used alone, and the treatment is ineffective or the condition is unstable;
It is difficult to distinguish the type of amiodarone-derived thyrotoxicosis.
What are the precautions when using methimazole for amiodarone-derived thyrotoxicosis?
Methimazole may cause liver function injury, bone marrow suppression, allergy and other adverse reactions. During treatment, routine blood test and liver function shall be re-examined on time according to the doctor's advice, and attention shall be paid to the presence of allergic symptoms such as skin pruritus, rash, nausea and vomiting, and epigastric discomfort. In case of any abnormality, seek medical advice immediately.
Does amiodarone primary thyrotoxicosis need reexamination after treatment? How to check again?
Thyroid function should be tested every 2 ~ 6 weeks after starting methimazole treatment, every 4 ~ 6 weeks during methimazole reduction period, and every 2 ~ 3 months during methimazole low-dose maintenance treatment period. Meanwhile, liver function and blood routine should be tested according to specific conditions.
Patients taking glucocorticoids are tested for thyroid function at least once a month and the interval for monitoring is extended appropriately after the condition stabilizes.
Can amiodarone source sex thyroid poison disease cure?
Although type I amiodarone-derived thyrotoxicosis can be controlled by methimazole, it may recur after drug discontinuation. It can also be completely cured by radiation 131I and surgery, but may result in permanent hypothyroidism.
Some type Ⅱ amiodarone-derived thyrotoxicosis can be cured after amiodarone is stopped and corresponding treatment is given.
What Should Be Noticed In The Life Of Patients With Amiodarone-derived Thyrotoxicosis
What should patients with amiodarone-derived thyrotoxicosis notice on diet?
During the disease is unfavorable edible iodine rich food, such as laver, kelp, shellfish, had better eat non-iodized salt. Avoid alcohol, coffee and tea.
Can patients with amiodarone-derived thyrotoxicosis have normal fertility?
If thyroid function reaches a normal range after treatment, fertility is not affected. In some patients with type II amiodarone-derived thyrotoxicosis, which may turn into permanent hypothyroidism, thyroid-stimulating hormone should be controlled below 2.5mIU/L to prepare for pregnancy so as not to affect fetal growth and development.