- 期刊
Amiodarone引起之甲狀腺功能低下併發黏液水腫昏迷：病例報告
Amiodarone-Induced Hypothyroidism with Myxedma Coma : A Case Report
摘要
Amiodarone是一種用來治療各種心律不整的藥物，屬於class III類，在此藥物副作用中甲狀腺功能異常發生率約14-18％，包括甲狀腺功能低下和甲狀腺毒症，但因其致病機轉不同而有不同的病程發展及治療。雖然此藥引起甲狀腺功能低下占大多數，但常會被忽略其症狀，尤其在老年人身上。倘若未儘早診斷治療，嚴重者會造成甲狀腺急症-黏液水腫昏迷（myxedema coma），進而導致死亡，死亡率約50-60%。在此提出一個79歲男性使用amiodarone後引起甲狀腺功能低下，因合併肺炎感染而導致myxedema coma的病例。我們的結論是使用amiodarone後，每3-6個月宜檢查 TSH, free T4等。若治療中發生甲狀腺機能低下或亢進徵兆，應馬上檢查甲狀腺功能並開始治療。
並列摘要
Amiodarone is a potent class III anti-arrhythmic drugs. About 14-18% o f amiodarone-treated patients developed overt thyroid dysfunction , including either amiodarone-induced hypothyroidism (AIH) or amiodarone-induced thyroitoxicosis (AIT). The clinical manifestations of AIH are usually being neglected especially in the elders although it is more common. If it has not been diagnosed earlier, it may induce thyroid crisis-myxedema coma and lead to death. The mortality of myxedema coma is about 50 to 60%. Here in, we report a case of 79- year- old male patient with hypothyroidism probably due to the chronic use of amiodarone, who developed myxedema coma due to pneumonia. The pathophy-siology of amiodarone-induced change in thyroid gland function as well as the follow-up and management strategy in patient with amiodarone-induced thyroid dysfunction will be discussed . It is important to evaluate patients before and during amiodarone therapy. We suggest check TSH, FT4 etc. every 3-6 months. If the signs and symptoms of hypothyroidism or hyperthyroidism are suspected during amiodarone treatment, we should check thyroid function and begin to treat at once.