ketendoКлиническая и экспериментальная тиреоидологияClinical and experimental thyroidology1995-54722310-3787Endocrinology Research Centre10.14341/ket12784ketendo-12784Research ArticleОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯORIGINAL STUDIESАмиодарон-индуцированный тиреотоксикоз 2 типа: факторы отсроченного ответа на терапию глюкокортикоидамиType 2 amiodarone-induced thyrotoxicosis: factors of delayed response to glucocorticoid therapyhttps://orcid.org/0000-0002-6471-8252ЕрмолаеваА. С.ErmolaevaA. S.

Ермолаева Александра Сергеевна.

119991, Москва, ул. Трубецкая, д. 8, стр. 2

Alexandra S. Ermolaeva – MD.

8-2 Trubetskaya street, 119991 Moscow

a.s.arkhipova@inbox.ruhttps://orcid.org/0000-0002-3026-6315ФадеевВ. В.FadeevV. V.

Фадеев Валентин Викторович - д.м.н., проф., член-корр. РАН.

Москва

Valentin V. Fadeyev - MD, PhD, Professor.

Moscow

walfad@mail.ruПервый Московский государственный медицинский университет им. И.М. Сеченова (Сеченовский Университет)РоссияI.M. Sechenov First Moscow State Medical University (Sechenov University)Russian Federation202411062024201414Copyright © Ермолаева А.С., Фадеев В.В., 20242024Ермолаева А.С., Фадеев В.В.Ermolaeva A.S., Fadeev V.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.cet-endojournals.ru/jour/article/view/12784ОБОСНОВАНИЕ

ОБОСНОВАНИЕ. Глюкокортикоиды являются препаратами первой линии для лечения амиодарон-индуцированного деструктивного тиреоидита. В связи с прогрессированием дисфункции левого желудочка, рецидивами нарушений ритма, увеличением риска неблагоприятных сердечно-сосудистых исходов у данной когорты пациентов, быстрое восстановление эутиреоза, особенно у лиц пожилого возраста, имеет решающее значение. Однако оно не всегда осуществимо с помощью медикаментозной терапии, поскольку непредсказуемо время достижения эутиреоза в каждом конкретном случае. Выявление факторов, позволяющих спрогнозировать эффективность и длительность терапии глюкокортикоидами, позволит определить верную тактику ведения пациентов.

ЦЕЛЬ

ЦЕЛЬ. Выявить факторы отсроченного ответа на терапию глюкокортикоидами у пациентов с амиодарон-индуцированным тиреотоксикозом 2 типа.

МАТЕРИАЛЫ И МЕТОДЫ

МАТЕРИАЛЫ И МЕТОДЫ. В исследование включены 11 пациентов ретроспективного и 22 пациента проспективного исследований в возрасте от 30 до 80 лет (21 мужчина и 12 женщин) с верифицированным амиодарон-индуцированным тиреотоксикозом 2 типа, получивших терапию преднизолоном в стартовой дозе 30 мг/сут. Проанализированы анамнестические, антропометрические данные, результаты лабораторно-инструментальной диагностики. Срок наблюдения пациентов составил от 1 года до 5 лет. Эффективность терапии оценивалась по времени достижения эутиреоза, длительности тиреотоксикоза, частоте повторных волн деструкции и рецидивов.

РЕЗУЛЬТАТЫ

РЕЗУЛЬТАТЫ. Средний возраст пациентов составил 57,0 [52,0; 66,0] лет. Через 1 месяц (30 дней) от начала терапии глюкокортикоидами эутиреоз достигнут у 17/33 (51,5%) пациентов, рсвТ4ГК-свТ4ГК1мес<0,001, рсвТ3ГК-свТ3ГК1мес<0,001. Отсроченное достижение эутиреоза (>30 дней) отмечалось у 48,5% пациентов. Медиана срока достижения эутиреоза составила 72,0±3,0 (95% ДИ: 66,1–77,9) дня, среднее время — 86,9±13,4 (95% ДИ: 60,6–113,1) дня. Медиана срока длительности тиреотоксикоза — 120,0±22,1 (95% ДИ: 76,6–163,4) дня, среднее время — 137,8±15,6 (95% ДИ: 107,2–168,4) дня. Уровень свТ4 через 30 дней терапии зависел от интервала «клиническая симптоматика — лабораторное подтверждение» (R²=0,120, р=0,049). Время достижения эутиреоза зависело от возраста (R²=0,185; р=0,013). Возраст также был предиктором возникновения повторных волн деструкции (ОШ=0,833, 95% ДИ: 0,709–0,978; R²=0,428, р=0,025).

ЗАКЛЮЧЕНИЕ

ЗАКЛЮЧЕНИЕ. Возраст пациента является прогностическим фактором для времени достижения эутиреоза при амиодарон-индуцированном тиреотоксикозе 2 типа.

BACKGROUND

BACKGROUND. Glucocorticoids are first-line drugs for the treatment of amiodarone-induced destructive thyroiditis. Due to the progression of left ventricular dysfunction, recurrence of rhythm disturbances and increased risk of adverse cardiovascular outcomes in this cohort of patients, rapid restoration of euthyroidism, especially in the elderly, is crucial. However, it is not always feasible with the drug therapy, because the time to achieve euthyroidism is unpredictable in each individual case. Identification of factors that allow predicting the efficacy and duration of glucocorticoid therapy will help to determine the correct tactics of patient management.

AIM

AIM. To identify factors of delayed response to glucocorticoid therapy in patients with type 2 amiodarone-induced thyrotoxicosis.

MATERIALS AND METHODS

MATERIALS AND METHODS. The study included 11 retrospective and 22 prospective patients aged 30 to 80 years (21 men and 12 women) with verified type 2 amiodarone-induced thyrotoxicosis, who received prednisolone therapy at a starting dose of 30 mg/day. Anamnestic, anthropometric data, results of laboratory and instrumental diagnostics were analyzed. The follow-up period of patients was 1–5 years. The effecasy of therapy was evaluated by the time to achieve euthyroidism, duration of thyrotoxicosis, frequency of repeated waves of destruction and relapses.

RESULTS

RESULTS. The average age of the patients was 57.0 [52.0; 66.0] years. After 1 month (30 days) from the start of glucocorticoid therapy, euthyroidism was achieved in 17/33 (51.5%) patients, pfT4GK-fT4GK1month<0.001, pfT3GK-fT3GK1month<0.001. Delayed achievement of euthyroidism (>30 days) was observed in 48.5% of patients. The median time to achieve euthyroidism was 72.0±3.0 (95% CI: 66.1–77.9) days, the average time was 86.9±13.4 (95% CI: 60.6–113.1) days. The median duration of thyrotoxicosis was 120.0±22.1 (95% CI: 76.6—163.4) days, the average time was 137.8±15.6 (95% CI: 107.2–168.4) days. The level of free thyroxine after 30 days of therapy depended on the interval «clinical symptoms — laboratory confirmation» (R2=0.120, p=0.049). Time to achieve euthyroidism depended on age (R2=0.185; p=0.013). Age was also a predictor of repeated waves of destruction (OR=0.833, 95% CI:0.709–0.978; R2=0.428, p=0.025).

CONCLUSION

CONCLUSION. Age is a predictive factor for the time to achieve euthyroidism in type 2 amiodarone-induced thyrotoxicosis.

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The authors declare that there are no conflicts of interest present.