AMIODARONE AND THE THYROID FUNCTION
Autori:
Tomislav Jukić, Marija Punda, Maja Franceschi, Josip Staničić, Roko Granić, Zvonko Kusić
Sažetak
Amiodaron je derivat benzofurana koji sadržava do 40% joda. Primjenjuje se za liječenje i prevenciju supraventrikularnih i ventrikularnih tahiaritmija opasnih po život. Učinak na štitnjaču očituje se od poremećaja funkcionalnih testova štitnjače do klinički izražene hipotireoze potaknute amiodaronom (AIH) i tirotoksikoze (AIT). Bolesnici s AIH liječe se supstitucijskom terapijom L-tiroksinom, a terapija amiodaronom može se nastaviti. Moramo razlikovati dva oblika AIT-a: hipertireoza potaknuta amiodaronom (AIT I) i tiroiditis (AIT II). AIT I liječi se tirostaticima, a metode definitivnog liječenja jesu jod-131 ili totalna tiroidektomija. Oblik II AIT-a liječi se glukokortikoidima. Bolesnici s AIT-om moraju prekinuti terapiju amiodaronom. Dronedaron je manje učinkovit antiaritmik koji je strukturno i farmakološki sličan amiodaronu, ali ne sadržavaju jod, a toksične nuspojave su rjeđe. Dronedaron se može rabiti za liječenje bolesnika s povećanim rizikom od razvoja AIT-a ili AIH.
Summary
Amiodarone is a benzofuran derivative that contains up to 40% of iodine. Amiodarone is used for treatment and prevention of life threatening supraventricular and ventricular tachyarrhythmias. The effects on thyroid gland vary from abnormalities in thyroid function tests to overt amiodarone induced hypothyroidism (AIH) and thyrotoxicosis (AIT). Patients with AIH are treated with L-thyroxine and may continue treatment with amiodarone. Two different forms of AIT have to be distinguished: amiodarone induced hyperthyroidism (AIT I) and thyroiditis (AIT II). AIT I is treated with antithyroid drugs, while total thyroidectomy and iodine-131 are used for definitive treatment. AIT II is treated with glucocorticoids. Patients with AIT have to stop treatment with amiodarone. Dronedarone is a less potent antiarrhythmic agent with structural and pharmacological properties similar to amiodarone. Dronedarone is devoid of iodine with fewer adverse effects and therefore it may be used in high risk patients for development of AIT or AIH.
