I-Amiodarone yisidakamizwa esiwusizo kakhulu e-antiarrhythm esake sakhiwa. Ngeshwa, libuye liyingozi kakhulu.
Phakathi kwezinkinga eziningi ezibonwa nge-amiodarone, ukukhathazeka kwe-thyroid kukhona okuvamile kakhulu. Isifo se-adiodarone esenzelwe isifo somzimba singaba nesisusa futhi singaba nzima ukubona. Ngaphezu kwalokho, izinkinga ze-thyroidarone ezibangelwa i-amiodarone ngokuvamile zilukhuni ukwelapha kunezinye izinhlobo zesifo se-thyroid.
Indlela i-Amiodarone eyenza ngayo i-Toxicity ye-Thyroid
I-Amiodarone ibangela izinkinga ze-thyroid ngezindlela ezimbili eziyinhloko. Okokuqala, i-amiodarone inokuqukethwe okuphezulu kakhulu kwe-iodine, futhi lapho abantu abathile betsha iodini enkulu kakhulu bangakwazi ukuthuthukisa isifo se-thyroid. Okwesibili, i-amiodarone ingaba nomthelela oqondile onobuchopho ngokwayo (okhiqiza uhlobo lwe-thyroiditis), futhi umuthi unganciphisa umsebenzi we-hormone ye-thyroid (ikakhulukazi, unganciphisa ukuguqulwa kwe-T4 kuya ku-T3, futhi unganciphisa ukubopha-ngakho-ke ukuphumelela-kwe-T3).
Izinkinga ze-thyroid zenziwe
I-Amiodarone ingaveza noma i-hypothyroidism (i-thyroid engasebenzi) noma i-hyperthyroidism (i-thyroid esebenzayo). Ucwaningo oluningi lunikeze izilinganiso ezihlukene zenkinga yezinkinga ze -roid nge-amiodarone, kodwa kubonakala sengathi iziguli ezingafika ku-30% eziphathwa nge-amiodarone zingahlakulela i-hypothyroidism, futhi kufike ku-10% ingaba ne-hyperthyroidism.
Ngenxa yokuthi i-amiodarone ihlala emzimbeni izinyanga eziningi (noma ngisho neminyaka) ngemuva kokuba umuthi umisiwe, izinkinga ze -roid zingathuthuka ngisho nangemva kokuba i-amiodarone ishiyiwe futhi odokotela kudingeka bahlale beqaphele mayelana nalokhu kungenzeka.
I-Hypothyroidism
Izimpawu ze-hypothyroidism ezibangelwa i-amiodarone zifana kakhulu nalabo abonwa ngezinye izinhlobo ze-hypothyroidism, futhi ngokuvamile zihlanganisa ukukhathala, ukutholakala kwesisindo, ukucabanga okungenangqondo, ukuvuvukala, ukuqothulwa nokucindezeleka.
Ukubona i- hypothyroidism kwiziguli ezithatha i-amiodarone kungaba yinto ekhohlisayo. I-Amiodarone ibangela ukuphakama kumazinga we-TSH cishe cishe wonke umuntu kuze kube izinyanga ezingu-6, ngakho-ke ochwepheshe batusa ukungenzi ukuxilongwa kwe-hypodroidism eyenziwe nge-amiodarone kuze kuboniswe ukuthi amazinga aphezulu we-TSH aqhubeka, noma amazinga we-T4 aphansi. Kodwa-ke, uma i-hypothyroidism ikhona (ngisho noma i- subclinical hypothyroidism ), kubalulekile ukwenza ukuxilongwa ikakhulukazi kubantu abanesifo senhliziyo esingaphansi.
Ukwelapha i-hypodroidism eyenziwa ngama-amiodarone ngokuyisisekelo kufana nokuphatha noma yiluphi olunye uhlobo lwe-hypothyroidism (okungukuthi, ngomlomo we-hormone ye-thyroid), kodwa, futhi, kungaba yinto eqotho ngoba i-amiodarone ingashintsha ukusebenza kwamahomoni wegciwane. Ezimweni eziningi, izidakamizwa ezishintshayo eziphakeme kakhulu kunezitho zomzimba zidingeka ukwelapha iziguli ze-hypothyroid ezithatha i-amiodarone. Ngenxa yalesi sizathu, eziningi zalezi ziguli zizokhonza kahle ukubona i-endocrinologist ekwazi ukusiza ukuphatha ukwelashwa kwabo.
Hyperthyroidism
Kunezinhlobo ezimbili ezahlukene lapho i-amiodarone ibangela i-hyperthyroidism. Kwezinye iziguli (ezinama- goiters angaphansi, noma nge- Graves's disease ), noma yimuphi ukwanda kokungenisa i-iodine kungabangela ukuthi i-thyroid iqale ukhiqiza ama-hormone amaningi wegciwane ngokweqile.
Futhi ukuthatha i-amiodarone inikeza i-thyroid nge-load enkulu ye-iodine.
Okwesibili, kwabanye abantu ama-amiodarone bangaba yingozi kulokhu okwenziwe yi- thyroiditis , okhiqiza i- thyroiditis eyonakalisayo. Kulesi simo, ukubhujiswa kwezicubu ze-thyroid kukhishwa amahomoni amaningi wegciwane egazini. Le-thyroiditis igcina "ishisa ngokwayo" uma kungekho nesikhumba se-thyroid esisele sokubhujiswa. Isiguli ke sibe i-hypothyroid. Kodwa okwamanje-okwamanje okungahlala izinyanga noma iminyaka-i-hyperthyroidism yinkinga.
Ukubonakaliswa kwemitholampilo ye-hyperthyroidism eyenziwe ngama-amiodarone kungahluka ku-hyperthyroidism engabangelwa yilo muthi.
Ngoba i-amiodarone inezimo zokuvimbela i-beta , futhi ngenxa yokuthi izidakamizwa zinganciphisa nesenzo se-hormone yegciwane, izimpawu eziningi ezivamile ze-hyperthyroidism (njenge-jitteriness, ukwesaba, ukukhathazeka, ukuzwela ukushisa, noma ukujuluka okukhulu ngokweqile), zifihliwe. Ngakho udokotela angase angacabangi ngokuxilongwa ngokushesha.
Iziguli ezine-hyperthyroidism ezibangelwa i-amiodarone zivame ukuzwa ukonakala kwezimpawu zenhliziyo. (Iziguli eziningi ezithatha lesi sidakamizwa ziyithatha ngenxa yesifo senhliziyo esisezingeni eliphansi.) Ngakho-ke zivame ukuqhuma ama-arrhythmias (ngokuvamile, ama-arrhythmias okuyi-amiodarone ayimisiwe kuqala), okwenza kube nzima ukuhluleka kwenhliziyo , ukuwohloka kwesifo se- coronary artery , i-low-grade fever, noma ukulahlekelwa isisindo ngaphandle kwesizathu esicacile. Odokotela abangaqaphile bangase bangacabangi ngezinkinga ze-thyroid uma izimpawu ezinjalo zikhula.
Ukwelashwa kwezifo ze-hyperthyroid ezibangelwa i-amiodarone kungaba nzima kakhulu. Izidakamizwa ze-Thionamide ezivimbela ukuqala kwe-hormone ye-thyroid (njenge-propylthiouracil-PTU), zivame ukusetshenziswa. I-Perchlorate, eyanciphisa ukutholakala kwe-iodine nge-gland yegciwane, ingaba usizo. Kodwa-ke, amanani ala mithi adingekayo ukunciphisa ukukhiqizwa kwehomoni ye-thyroid ngokuvamile ephakeme kakhulu ezigulini ezithatha i-amiodarone, futhi kungaba yinselele ukusebenzisa lezi zidakamizwa ngempumelelo. Okubi nakakhulu, uma i-hyperthyroidism ibangelwa i-amiodarone-induced thyroiditis, izidakamizwa ezihloswe ukunciphisa ukukhiqizwa kwamahomoni e-thyroid ngokuvamile azisebenzi nhlobo, kanti i-thyroidectomy (ukuhlinzwa kwe-thyroid-removal) yindlela kuphela yokusebenza.
Ukwehla kwe-thyroid ne-iodine emisebe yomsakazo-inqubo engavumeleki esebenza kahle ngendlela ejwayelekile ye-hyperthyroidism-ngokuvamile akuyona inketho kwisiguli esithatha i-amiodarone. Lokhu kungenxa yokuthi igciwane le-thyroid kulezi ziguli selivele ligcwele ngokweqile ukuthi i-thyroid ye-iodine ye-radioactive iyancipha kakhulu.
Uma i-hyperthyroidism ibangela ukuhluleka kwenhliziyo, i- angina engaqiniseki , noma i-arrhythmias esongela ukuphila, ingase ibe yiphuthumayo yokuthola ukwelashwa okuphumelelayo ngokushesha ngangokunokwenzeka-okwenza kube nzima nakakhulu ngezinketho zokwelapha ezincishisiwe kakhulu. Kunoma yikuphi, ukuphatha i-amiodarone-induced hyperthyroidism kunzima kangangokuthi isazi se-endocrinology kufanele sithinte ngaso sonke isikhathi.
Ngaphansi
Izifo ze-thyroid zivame ezigulini ezithatha i-amiodarone. Lezi zinkinga zingase kube nzima ukubona, kunzima ukuphatha, futhi ngezikhathi ezithile zingasongela ukuphila. Kubalulekile ukuba uqaphele ukuthi kungenzeka izinkinga ze -roid kunoma ngubani othaka i-amiodarone.
Ikhono lemiphumela emibi ye -roid yisisodwa esinye isizathu esenza odokotela bahlale behluleka ukubeka i-amiodarone. Uma bebona kudingekile ukwenza kanjalo, kufanele bazizwe bebophekile ukuba balandele lezi ziguli ngokucophelela, iminyaka uma kunesidingo, ukuze baqaphele imiphumela emibi ye -roid, kanye nayo yonke eminye imiphumela emibi ebonwe nalo muthi.
Imithombo:
I-Basaria S, Cooper DS. I-Amiodarone ne-thyroid. Am J Med 2005; 118: 706.
UBogazzi F, uBartalena L, Martino E. Indlela eya kwesiguli nge-thyodtoxicosis eyenziwe nge-amiodarone. J Clin Endocrinol Metab 2010; 95: 2529.