I-Amiodarone yilezi zixhobo ezithintekayo ezichanekileyo eziye zaphuhliswa. Ngelishwa, yinto enobuthi kakhulu.
Phakathi kweengxaki ezininzi ezibonwa ngama-amiodarone, iingxaki ze-thyroid zizinye zezona ziqhelekileyo. Isifo se-thyroid-induced u-Amiodarone sinokubaluleka kwaye kuya kunzima ukuyiqonda. Ukongezelela, ukukhathazeka kwe-thyroidarone-induced thyroid ngokuvamile kunzima ukunyanga kunezinye iintlobo zesifo se-thyroid.
Indlela i-Amiodarone ibangela ngayo i-Thyroid Toxicity
I-Amiodarone ibangela iingxaki ze-thyroid ngeendlela ezimbini ezibalulekileyo. Okokuqala, i-amiodarone inomxholo ophezulu kakhulu we-iodine, kwaye xa abantu abathile bethetha inani elikhulu le-iodine banokuhlakulela isifo se-thyroid. Okwesibini, i-amiodarone ingaba nefuthe ngqo kwi-thyroid gland ngokwayo (ukuvelisa uhlobo lwe-thyroiditis), kunye neziyobisi zinganciphisa umsebenzi wee-hormone ze-thyroid (ngokukodwa, inokunciphisa ukuguqulwa kweT4 ukuya kwi-T3, kwaye inganciphisa ukubopha-kwaye ngoko kusebenza-kweT3).
Iingxaki zeTyroid zenziwe
I-Amiodarone inokuvelisa i-hypothyroidism (i-thyroid engekho ngaphantsi) okanye i-hyperthyroidism (i-thyroid ephezulu). Izifundo ezahlukahlukeneyo zinike iziqikelelo ezahlukileyo zeengxaki ze-thyroid kunye ne-amiodarone, kodwa kubonakala ukuba ukuya kwi-30% yezigulane eziphathwe nge-amiodarone zingahlakulela i-hypothyroidism, kwaye ukuya kwi-10% inokuphuhlisa i-hyperthyroidism.
Ngenxa yokuba i-amiodarone ihlala emzimbeni kwiinyanga ezininzi (okanye nangeminyaka) emva kokuba isigxina simisiwe, iingxaki ze-thyroid zingakhula nangemva kokuba i-amiodarone ishiyiwe kwaye oogqirha kufuneka bahlale bephaphele malunga nale nto.
Hypothyroidism
Iimpawu ze-hypothyroidism ezibangelwa yi-amiodarone zifana nezo zibonwa ngezinye iintlobo ze-hypothyroidism, kwaye ziquka ukukhathala, ukufumana ubunzima, ukucinga, ukukhukhumeza, ukuzithemba nokuxinezeleka.
Ukufumanisa i- hypothyroidism kwizigulane ezithatha i-amiodarone zinokuba zikhohlisayo. I-Amiodarone ibangela ukuphakama kumanqanaba e-TSH phantse wonke umntu ukuya kwiinyanga ezi-6, ngoko ke iingcali zincoma ukuba zingaboni ukuxilongwa kwe-hypodroidism eyenziwe ngama-amiodarone ade iboniswe ukuba amazinga e-TSH aphakamileyo aqhubekayo okanye ukuba amazinga e-T4 aphantsi. Nangona kunjalo, ukuba i-hypothyroidism ikhona (nangona i- hypclinroidism i - subclinical hypothyroidism ), kubalulekile ukwenza ukuxilongwa ngakumbi kubantu abanesifo senhliziyo.
Ukwelapha i-amiodarone-induced hypothyroidism ngokukodwa kufana nokunyanga nawuphi na uhlobo lohlobo lwe-hypothyroidism (oko kukuthi, nge-hormone ye-thyroid), kodwa, kwakhona, kunokuba lukhuni ngenxa yokuba i-amiodarone ingatshintsha ukuphumelela kwe-hormone ye-thyroid. Kwiimeko ezininzi, amayeza aphezulu kunokuba aqhelekileyo enyango ye-thyroid kufuneka ayiphathe izigulane ze-hypothyroid ezithatha i-amiodarone. Ngenxa yesi sizathu, ezininzi zezi gulane ziya kuncedwa ukubona i-endocrinologist enamava ekuncedeni ukulawula unyango lwabo.
Hyperthyroidism
Kukho iindlela ezimbini ezahlukeneyo apho i-amiodarone ibangela i-hyperthyroidism. Kwezinye izigulane (abo abanezintlu ezisemgangathweni, okanye ngesifo se- Graves ), nayiphi na ukwanda kwe-iodine yokungenisa kunokubangela ukuba i-thyroid iqale ukuvelisa ubuninzi behomoni ye-thyroid.
Futhi ukuthatha i-amiodarone iveza i-thyroid nge-heavy iodine load load.
Okwesibini, kwezinye i-amiodarone ingaba yityhefu kwi-tishu ye-thyroid ngokwayo, ivelise i- thyroiditis eyonakalisayo. Kule meko, ukutshatyalaliswa kwezicubu ze-thyroid kukhulula i-hormone ye-thyroid kwigazi. Le thyroiditis ekugqibeleni "iyitshisa" xa kungekho zicubu ze-thyroid eziza kubhujiswa. Isigulane siba yi-hypothyroid. Kodwa okwangoku-okwangoku kunokuhlala iinyanga okanye iminyaka-i-hyperthyroidism yinkinga.
Ukubonakaliswa kweklinikhi ye-hymthyroidism eyenziwa ngama-amiodarone inokungafani ne-hyperthyroidism engabangelwa yili chiza.
Ngenxa yokuba i-amiodarone ineempembelelo ze-beta-blocking effect, kwaye ngenxa yokuba le nkunkuma inganciphisa intshukumo ye-hormone ye-thyroid, ezininzi iimpawu eziqhelekileyo ze-hyperthyroidism (ezifana nokuhlamba, ukukhathazeka, ukukhathazeka, ukuzwela kobushushu, okanye ukujuluka okugqithiseleyo), zifihliwe. Ngoko ugqirha akanakho ukucinga ngokuxilongwa ngokukhawuleza.
Izigulane ezine-amiodarone-ezibangelwa i-hyperthyroidism ziyakwazi ukuhlaselwa kweempawu zesifo. (Izigulane ezininzi ezithatha le nkunkuma ziyithatha njengesiphumo sesifo senhliziyo.) Ngoko bahlala bexakeka kakhulu kwiimpawu zokuhlala (ngokuqhelekileyo, i-arrhythmias apho i-amiodarone imiselwe khona kwindawo yokuqala), ukonakalisa ukungaphumeleli kwintliziyo , ukuphazamisa iimpawu zesifo se- coronary , i-fever-grade-grade, okanye ukulahleka kwesisindo ngenxa yesizathu esicacileyo. Oogqirha abangaboniyo abanakho ukucinga ngeengxaki ze-thyroid xa iimpawu ezinjalo zikhula.
Unyango lwe-amiodarone-induced hyperthyroid lungaba nzima. Amachiza e-Thionamide avimbela ukusetyenziswa kwehomoni ye-thyroid (njengepropylthiouracil-PTU), isetyenziswa rhoqo. I-Perchlorate, eyanciphisa i-iodine nge-thyroid gland, inokuba luncedo. Nangona kunjalo, amanyathelo ala mayeza afunekayo ukunciphisa imveliso ye-hormone ye-thyroid idla ngokugqithiseleyo kwizigulane ezithatha i-amiodarone, kwaye kunokuba ngumngeni wokusebenzisa le michiza ngokufanelekileyo. Okubi kakhulu, ukuba i-hyperthyroidism ibangelwa yi-amiodarone-induced thyroiditis, iziyobisi ezijolise ekunciphiseni imveliso ye-hormone ye-thyroid ngokuvamile ayisebenzi, kwaye i-thyroidectomy (ukukhutshwa kwe-thyroid-removal) yindlela kuphela.
I-thylation ye-thyroid kunye ne-iodine e-radioactive-inkqubo engeyiyo ingavumelekanga esebenzayo kakuhle kwi-hyperthyroidism-ngokuqhelekileyo ayikho inketho kwisigulane esithatha i-amiodarone. Oku kungenxa yokuba isifo se-thyroid kulezi zigulane sele sithwele kakhulu nge-iodine ukuba i-thyroid ifunyenwe iodod i-radio iyancipha kakhulu.
Ukuba i-hyperthyroidism ibangela ukungaphumeleli kwintliziyo, i- angina engaqinisekanga , okanye i-arrhythmias esongela ubomi, ingaba yimeko engxamisekileyo yokufumana unyango olusebenzayo ngokukhawuleza kangangoko-oko kwenziwa nzima kakhulu ngokunciphisa ukhetho olunonyango oluncinci. Kukho nawuphi na, ukunyanga i-amiodarone-induced hyperthyroidism kunzima kangangokuthi i-endocrinology ingcali kufuneka ihlale ibandakanyeka.
Okukwintsusa
Iingxaki zeTyroid ziqhelekileyo kwizigulane ezithatha i-amiodarone. Ezi ngxaki zingaba nzima ukuyiqonda, kunzima ukunyanga, kwaye ngezinye izihlandlo zingasongela ubomi. Kubalulekile ukuba uqaphele ukuba kwenzeka ukuba iingxaki ze-thyroid zenzeke kumntu othabatha i-amiodarone.
Imiphumo yegalelo ye-thyroid iyona sizathu esinye isizathu sokuba kutheni oogqirha bamele bahlale bexhala ukumisela i-amiodarone. Ukuba bafumene imfuneko yokwenza njalo, ngoko kufuneka bazive benyanzelekile ukuba balandele ngokunyanisekileyo ezi gulane, kwiminyaka xa kuyimfuneko, ukwenzela ukubeka iliso kwimiphumo emibi ye-thyroid, kunye nazo zonke ezinye iziphumo ezichaphazelekayo kunye nale nkunkuma.
Imithombo:
Basaria S, Cooper DS. Amiodarone kunye ne-thyroid. Ngomhla wama-2005; 118: 706.
UBogazzi F, uBartalena L, Martino E. Indlela kwisigulane kunye ne-amiodarone-induced thyrotoxicosis. J Clin Endocrinol Metab 2010; 95: 2529.