ketendoКлиническая и экспериментальная тиреоидологияClinical and experimental thyroidology1995-54722310-3787Endocrinology Research Centre10.14341/ket2017231-38ketendo-8779Research ArticleОбзоры литературыReview of literatureАмиодарон-индуцированный тиреотоксикоз. Современный взгляд на проблемуAmiodarone-induced thyrotoxicosis: state of the arthttps://orcid.org/0000-0001-6494-3778ЛебедеваЕлена АлексеевнаLebedevaElena A.

д.м.н., профессор

MD, PhD, Professor

endocrinolog63@mail.ruhttps://orcid.org/0000-0003-1760-2860ЯблонскаяЮлия АлександровнаIablonskaiaIuliia A.

врач-кардиолог

MD

yalia_medik@mail.ruhttps://orcid.org/0000-0003-0027-1786БулгаковаСветлана ВикторовнаBulgakovaSvetlana V.

д.м.н., доцент

MD, PhD

info@samsmu.ru<p>ФГБОУ ВО &ldquo;Самарский государственный медицинский университет&rdquo;</p>Россия<p>Samara State Medical University</p>Russian Federation<p>ГБУЗ &ldquo;Самарский областной клинический кардиологический диспансер&rdquo;</p>Россия<p>Samara regional cardiological dispensary</p>Russian Federation2017111020171323138Copyright &#x00A9; Лебедева Е.А., Яблонская Ю.А., Булгакова С.В., 20172017Лебедева Е.А., Яблонская Ю.А., Булгакова С.В.Lebedeva E.A., Iablonskaia I.A., Bulgakova S.V.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.cet-endojournals.ru/jour/article/view/8779

В обзоре представлены данные литературы последних лет о патогенезе, диагностике, лечении амиодарон-индуцированного тиреотоксикоза (АИТ), который является частым осложнением терапии амиодароном (Ам). Описаны изменения секреции и метаболизма тиреоидныхгомонов под влиянием кратковременной и длительной терапии Ам. Развитие АИТ всегда приводит к ухудшению течения аритмии, усугублению недостаточности кровообращения, утяжелению состояния пациента. Выделяют АИТ 1 типа и АИТ 2 типа, а также смешанную форму. Описаны диагностические критерии АИТ 1 и 2 типа. Наиболее информативным тестом для дифференциальной диагностики АИТ 1, 2 типов и смешанных форм является сонография щитовидной железы с допплеровским исследованием кровотока и сканирование с 99mTc-sestaMIBI. Тактика лечения определяется типом АИТ, состоянием сердечно-сосудистой системы, риском повторных аритмий. Консервативное лечение зависит от типа АИТ и осуществляется тиреостатиками или глюкокортикоидами. Обсуждается возможность продолжения антиаритмической терапии Ам у пациентов, перенесших АИТ. При АИТ 1 типа и смешанной форме требуется отмена препарата, если это невозможно – радикальное лечение тиреотоксикоза (радиойодтерапия, тиреоидэктомия). АИТ 2 типа является самолимитирующимся процессом, при жизненно угрожающих аритмиях прием Ам может быть продолжен. Показана эффективность радиойодтерапии для радикального лечения тиреотоксикоза при АИТ 1 и 2 типа, несмотря на низкий захват радиойода. Однако этот вопрос требует дальнейшего изучения и обсуждения. Для быстрого восстановления эутиреоза у тяжелых больных применяют плазмаферез и тиреоидэктомию.

The review presents recent data on the pathogenesis, diagnosis and treatment of amiodarone-induced thyrotoxicosis (AIT), which is a frequent complication of amiodarone (Am) therapy. Changes in secretion and metabolism of thyroid hormones are described under the influence of short-term and long-term therapy. The development of AIT leads to worsening of arrhythmias, aggravation of circulatory insufficiency, deterioration of the patient’s condition. Two types of AIT are distinguished, as well as mixed form. Diagnostic criteria of AIT type 1 and AIT type 2 are described. The most informative test for differential diagnosis between first and second types of AIT and mixed forms is ultrasound examination of the thyroid gland with Doppler blood flow evaluation and radionuclide scanning with 99 mTc-sestaMIBI. Medical management is determined by the type of AIT, the state of cardiovascular system and the risk of recurrent arrhythmias. Pharmacological management of AIT depends on it’s type and comprises the use of anti-thyroid medications or glucocorticoids. The possibility of continuing antiarrhythmic amiodarone therapy in patients who underwent AIT is discussed. In patients with AIT type 1 and mixed form drug cancellation is required, if this is not possible – radical treatment of thyrotoxicosis (radioiodine therapy, thyroidectomy) is applied. AIT type 2 is a self-limiting process with life-threatening arrhythmias, and amiodarone therapy can be continued. The effectiveness of radioiodine therapy for radical treatment of AIT type 1 and type 2 is shown in spite of low radioiodine capture. However, this issue requires further investigation and discussion. Plasmapheresis and thyroidectomy are used for rapid restoration of euthyroidfunction in severe patients.

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