Halit ACET, Rida BERİLĞEN, Ferhat ÖZYURTLU, Cem NAZLI, Oktay ERGENE, Hamza DUYGU, Faruk ERTAŞ

Türkiyede Ege bölgesi populasyonunda amiodaronun tiroid fonksiyonları üzerinde kısa dönem etkileri: İleriye dönük bölgesel ve gözlemsel bir çalışma

Amaç: Bu yazıda amiodaronun tiroid fonksiyonları üzerindeki kısa dönem etkilerini, oral ve infüzyon dozlarınının tiroid fonksiyonları üzerindeki etkisini araştırmak amaçlanmıştır.Yöntemler: Kliniğimize atrial ve ventriküler aritmilerle başvurup amiodaron başlama endikasyonu olan ardışık 155 ötroid hasta çalışmaya alındı. Hastaların 134'üne 16 mg/kg dozunda 24 saat IV amiodaron infüzyonu takiben bir ay boyunca oral 500±100 mg/gün, geriye kalan 21 hastaya ise sadece oral 500±100 mg/gün amiodaron başlandı. Hastalar tedavinin birinci ayında kontrole çağrıldı.Bulgular: Çalışmaya alınan hastaların %68'i erkek olup hastaların ortalama yaşı. 62,8±13,5 idi. Amiodaron başlama endikayonu olan hastaların %41'i atrial fibrilasyon, % 41'i ventriküler taşikardi, %5'i preoperatif, %5'i supraventriküler taşikardi, %5'i atriyal flutter, %3'ü ventriküler fibrilasyondu. Birinci ay kontrolünde %83 hastada ötiroid durum, % 17 hastada ise amiodarona bağlı tiroid disfonksiyonu (TD) saptandı. TD saptanan hastaların %5'i subklinik hipotiroidi, %5'i aşikar hipotiroidi, %7'si subklinik hipertiroidi, %1'inde de aşikar hipertiroidi gelişmişti. Sonuçlar: Bu çalışmada amiodaronun kısa dönemde de tiroid fonksiyonları üzerinde olumsuz etki yapabileceğini gösterdik. Bu nedenle amiodaron tedavisi başlanan hastalar birinci ay, üçüncü ay, altıncı ay ve onikinci ay kontrole çağrılmalıdır. Böylece amiodaron tedavisi alması zorunlu hastalarda gelişecek olan TD erkenden tespit edilebilecek ve uygun tedavi başlanabilecektir.

Short-Term effects of amiodarone on thyroid function on Aegean region population of Turkey: A prospective regional and observational study

Objective: We aimed to investigate short term effects of oral and infusion dosages of amiodarone on thyroid function. Methods: A hundred and fifty-five prospectively consecutive patients with a diagnosis of atrial or ventricular arrhythmias admitted to our clinic whom amiodarone were applied enrolled to our study. 134 patients received 16 mg/kg amiodarone iv infusion for 24 hours and oral 500±100 mg/day amiodarone as the maintenance dose for one month. 21 patients received only oral 500±100 mg/day amiodarone dose for one month. Follow up visit was performed in the first month of amiodarone therapy.Results: In this study 68% of patients were male and the average age of the patients was 62.8±13.5. The indications for amiodarone treatment were atrial fibrillation (41%), ventricular tachycardia (41%), and preoperative (5%), supraventricular tachycardia (5%), atrial flutter (5%), and ventricular fibrillation (3%). At the first month of follow up 83% of patients were in euthyroid state, 17% of the patients had amiodarone induced thyroid dysfunction (TD), 5% of patients had subclinical hyperthyroidism, 5% of patients had manifest hypothyroidism, 7% of patients had subclinical hyperthyroidism, and 1% of the patients developed overt hyperthyroidism.Conclusion: In this study we showed that amiodarone can cause adverse effects on thyroid function in a short time of period. For this reason patients should be followed in the first, third, sixth and twelfth months of amiodarone therapy and thyroid function should be evaluated.

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Reifel JA Estes NA, Waldo AL, et al. A Consensus report on antiarrhytmic drug use. Clinic Cardiol 1994;17:103- 116.
Holt DW Tucker GT, Jackson PR, Storey GCA. Amioda- rone pharmacokineticks. AM Heart J 1983;106:843-847.
Lombardi A,Martino E, Braverman LE. Amiodarone and the thyroid. Thyroid Today 1990; 13:1-7.
Acet H, Ertaş F, Özyurtlu F. Amiodarone Induced Epididy- mitis: A Case Report. Int J Basic Clin Studies (IJBCS) 2013;1:89-91.
Ünal N, Gürlek A. Amiodaron ve tiroid. Hacettepe Tıp Der- gisi 2005;36:152-156.
Wiersinga WM. Amiodarone and the thyroid. In: Weetman AP Grossman A (eds) Pharmacotherapeuticks of the thyroid gland. Berlin: Springer Verlag 1997;225-287.
Harjai KJ, Licata AA. Effectsof amiodarone on thyroid dys- function. Ann I ntern Med 1997;126:63-73.
Iudica Souza C, Burch HB. Amiodarone induced thyroid dysfunction. The Endocrinologist 1999;9:216-227.
Safran M Fan SL, Bambini G, Pinchera A, et al. Effects of amiodarone and desethylamiodarone on pituitary deio- dinase activity and thyrotropin secretion in the rat. Am J Med Sci 1986;29:136-141.
Chivato L, Martino E, Tonacchera M, et al. Studies on the in vitro cytotoxic effects of amiodarone. Endocrinology 1994;134:2277-2282.
Rabiowe SL, Larsen PR, Antman EM, et al. Amiodarone therapy and autoimmune thyroid disease, increase in a new monoclonal antibody defined T cell subset. Am J Med 1986;81:53-57.
Albert SG, Alves LE, Rose EP. Thyroid dysfunction during chronic amiodarone therapy. J Am Coll Cardiol 1987;9:175-183
Thorne SA, Barnes I, Cullinan P, Somerville J. Amioda- rone-associated thyroid dysfunction risk factors in adults with congenital heart disease. Circulation 1999;100:149- 154.
Martino E, Mariotto S, Aghini-Lombardi F, et al. Short term administration of potasyum perchlorate restores euthyroidism in amiodarone iodine induced hypothyroid- ism. J Clin Endocrinol Metab 1986;63:1233-1236.
ACC/AHA/ESC guidelines for the management of pa- tients with atrial fibrillation. Euro Heart J 2001;22:1852- 2128.
Bradley D, Lawrence L. Creswell, et al. Pharmacolog- ic prophylaxis. American college of chest physicians guidelines for the prevention and management of post- operative atrial fibrillation after cardiac surgery. Chest 2005;128:39-47.
Levy S, Camm AJ, Saksena S, et al: International con- sensus on nomenclature and classification of atrial fibril- lation. Europace 2003;5:119-122.
Atriyal Fibrilasyon Hastalarının Tedavisi için ACC/AHA/ ESC 2006 Kılavuzu Türk Kardiyol Dern Arş 2007;Suppl 3:
Supraventricular Arrhythmias (ACC/AHA/ESC Guide- lines for the Management of Patients with EHJ 2003;24:1857-1897.
Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death ACC/AHA/ESC 2006 Guidelines for Man- agement of Patients with EHJ 2006;27:2099-2140.
Amiodaron Trials Meta-Analysis Investigators: Effect of prophylactic amiodarone on mortality after acute myo- cardial infarction and in congestive heart failure: meta- analysis of individual data from 6500 patients in ran- domised trials. Lancet 1997;350:1417-1424.
Hohnloser SH, Singh BN. Proarrhythmia with class III an- tiarrhythmic drugs: definition, electrophysiological mech- anisms, incidence, predisposing factors, and clinical im- plications. J Cardiovasc Electrophysiol 1995;6:920-936.
Martino E, Aghini-Lombardi F, Mariotti S, et al. Amioda- rone: A common source of iodine induced thyrotoxicosis. Horm Res 1987;26:158-171.
Lee KF, Lee KM, Fung TT. Amiodarone-induced thyroid dysfunction in the Hong Kong Chinese population. Hong Kong Med J 2010;16:434-439.
Huang CJ, Chen PJ, Chang JW, et al. Amiodarone-in- duced thyroid dysfunction in Taiwan: a retrospective co- hort study. Int J Clin Pharm 2014. [Epub ahead of print]
Farhan H, Albulushi A, Taqi A, et al. Incidence and pat- tern of thyroid dysfunction in patients on chronic amio- darone therapy: experience at a tertiary care centre in Oman. Open Cardiovasc Med J 2013;7:122-6.
Singh BN, Singh SN, Reda DJ, et al. Sotalol Amiodarone Atrial Fibrillation Efficacy Trial (SAFE-T) Investigators Amiodarone versus sotalol for atrial fibrillation. N Engl J Med 2005;352:1861-1872.
Batcher EL, Tang XC, Singh BN, et al; SAFE-T Inves- tigators. Thyroid function abnormalities during amioda- rone therapy for persistent atrial fibrillation. Am J Med 2007;120:880-905.