Nezahat Müge ÇATIKKAŞ, Hülya HACİŞAHİNOĞULLARI, Nurdan GÜL, Özlem SOYLUK SELÇUKBİRİCİK, Ferihan ARAL, Refik TANAKOL, Ayşe KUBAT ÜZÜM

AMİODARONA BAĞLI TİROTOKSİKOZDA TANI YÖNTEMLERİ VE TEDAVİ SEÇENEKLERİNİN RETROSPEKTİF DEĞERLENDİRİLMESİ

Amaç: Amiodarona bağlı tirotoksikoz (ABT) hekimler için tanıması ve yönetimi zor, morbidite ve mortalitesi yüksek bir durumdur. Bu çalışmada ABT tanısı, sınıflandırılması ve tedavi için kullanılan parametrelerin retrospektif olarak incelenmesi amaçlanmıştır. Gereç ve Yöntem: Amiodarona bağlı tirotoksikoz nedeniyle ayaktan tedavi gören hastalar dahil edildi. Demografik özellikler, kalp ve tiroid hastalıklarının varlığı ve özellikleri, amiodaron maruziyetinin zamanı ve dozu, tiroid fonksiyon testleri ve otoantikorları ve tiroid hastalığının tanı yöntemleri ve yönetimi kaydedildi. Bulgular: Tip 1 (n:12; %48), tip 2 (n:7; %28) ve mikst tip (n:6; %24) ABT olarak sınıflandırılan 25 hasta (ortalama yaş: 64,1±15,3 yıl, %56’sı erkek) çalışmaya dahil edildi. Tip 1 ABT, tip 2 ABT ile karşılaştırıldığında, serbest T3 ve T4 konsantrasyonları sırasıyla 5,1±1,6 pmol/L’ye karşı 7,6±2,4 pmol/L ve 29,2±8,8 pmol/L’ye karşı 34,9±11 pmol/L idi. İkinci saat radyoaktif iyot tutulumu 24. saat radyoaktif iyot tutulumu ile pozitif korelasyon gösterdi (p=0.005). Tedavide sırasıyla, antitiroid ilaç (n:20) 24 ay, glukokortikoid (n:7) 7,4±1,7 ay ve sodyum perklorat (n:5) 3,5±2 ay kullanıldı. Tip 1 ABT için ilk tedavi seçeneği metimazol ve tip 2 ABT için metilprednizolon idi. Tip 2 ABT ‘da remisyon süresi daha kısaydı (p=0,009). Beş hastaya radyoaktif iyot tedavisi, bir hastaya tiroidektomi uygulandı. Sonuç: Amiodaron ile indüklenen tirotoksikozların yönetimi zordur. Bu hastaların tekrar amiodarona ihtiyaç duyabileceği akılda tutulmalı, bu nedenle ihtiyaç halinde ablatif tedaviler planlanmalıdır.

Anahtar Kelimeler:

Amiodaron tirotoksikozu, metimazol, metilprednizolon, perklorat

RETROSPECTIVE EVALUATION OF DIAGNOSTIC METHODS AND TREATMENT OPTIONS IN AMIODARONE-INDUCED THYROTOXICOSIS

Objective: Amiodarone-induced thyrotoxicosis is an important cause of morbidity and mortality that is difficult for physicians to recognize and manage. We retrospectively analyzed the parameters used for diagnosis, classification, and treatment for amiodarone-induced thyrotoxicosis. Material and Method: We included patients who had amiodarone-induced thyrotoxicosis (AIT). We recorded the demographics, the presence and characteristics of heart and thyroid diseases, the time and dosage of amiodarone exposure, thyroid function tests and thyroid auto-antibodies, and the diagnostic methods and management of thyroid disease. Result: We included 25 patients (mean age: 64.1±15.3 years, 56% male) who were classified as type 1 (n:12; 48%), type 2 (n:7; 28%), and mixed-type amiodarone-induced thyrotoxicosis (AIT) (n:6; 24%). In the comparison of type 1 AIT to 2 AIT, free T3 and T4 concentrations were 5.1±1.6 pmol/L vs. 7.6±2.4 pmol/L, and 29.2±8.8 pmol/L vs. 34.9±11pmol/L, respectively. Iodine uptake measurement at the 2nd hours were positively correlated with the 24th-hour measurement (p=0.005). Antithyroid drug (n:20) was given for 24 months, glucocorticoid (n:7) and sodium perchlorate (n:5) were given for 7.4±1.7 and 3.5±2 months, respectively. The first treatment option was methimazole for type 1 AIT and methylprednisolone for type 2 AIT. The duration of remission was shorter in type 2 AIT (p=0.009). Five patients had radioactive iodine treatment, and one underwent thyroidectomy. Conclusion: The management of AITs is difficult. It should be kept in mind that these patients may need amiodarone again; therefore, ablative treatments should be planned if needed.

Keywords:

Amiodarone induced thyrotoxicosis, methimazole, methylprednisolone, perchlorate,

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