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Amiodarone-induced thyroid dysfunction associated with cumulative dose.

机译：胺碘酮引起的甲状腺功能不全与累积剂量有关。

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PURPOSE: To obtain risk estimates of thyroid disorder in patients starting amiodarone. METHODS: We followed a cohort of 5522 patients with a first prescription for an anti-arrhythmic drug and no previous use of thyroid drugs. Within this cohort we conducted a nested case-control analysis. Cases were defined as all patients who started a thyreomimetic or thyreostatic drug no sooner than 3 months after the start of an anti-arrhythmic drug. Controls were patients with a comparable follow-up period not receiving any thyroid drugs during the observation period. RESULTS: We identified 123 cases who had started thyreostatic drugs and 96 cases who had started a thyreomimetic drug. In users of amiodarone we found an adjusted odds ratio of 6.3 (3.9-10.2) for hyperthyroidism and 6.6 (3.9-11.1) for hypothyroid disease compared to users of other antiarrhythmics. Patients who were exposed to a cumulative dose exceeding 144 g of amiodarone had an adjusted odds ratio of 12.9 (6.1-27.3) for the development of hyperthyroid disease. The dose response for development of hypothyroidism was less pronounced. CONCLUSIONS: We observed an increased risk for thyroid disorder at the high end of that reported in the literature. The risk of thyroid disorder increased with exposure to higher cumulative doses. Clinicians should keep in mind the possibility of development of thyroid disorders in patients on treatment with amiodarone even after several years of use.
机译：目的：获得开始胺碘酮治疗的患者甲状腺疾病的风险评估。方法：我们追踪了5522名患者，他们均使用了抗心律不齐药物的首次处方，并且以前没有使用过甲状腺药物。在这个队列中，我们进行了嵌套的病例对照分析。病例定义为所有在开始抗心律不齐药物后3个月内开始使用拟甲状腺素或镇静药物的患者。对照组是随访期相近的患者，在观察期内未接受任何甲状腺药物。结果：我们确定了123例开始使用止血药的患者和96例开始使用了拟甲状腺素药物的患者。与其他抗心律失常药的使用者相比，胺碘酮的使用者甲状腺功能亢进症的调整比值比为6.3（3.9-10.2），甲状腺功能减退者的调整比值比为6.6（3.9-11.1）。暴露于累积剂量超过144 g胺碘酮的患者甲状腺功能亢进症发展的调整比值比为12.9（6.1-27.3）。甲状腺功能减退的剂量反应不太明显。结论：我们观察到甲状腺疾病的风险比文献报道的高。暴露于更高的累积剂量会增加甲状腺疾病的风险。即使使用几年后，使用胺碘酮治疗的患者，临床医生也应谨记甲状腺疾病的可能性。

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