Amiodarone ndiyo inonyanya kushandisa antiarrhythmic mishonga iyo yakambotangwa. Zvinosuruvarisa, iyo ndiyo inonyanya kutyisa.
Pakati pematambudziko akawanda anoonekwa neamayodarone, zvinetso zvetachiona ndezvimwe zvinowanzoitika. Amiodarone-inokonzerwa nehutachiona chirwere inogona kuva yakakosha uye inogona kuva yakaoma kuziva. Uyezve, zvirwere zveyodiodarone-inokonzerwa nehutachiona kazhinji zvakaoma kurapa kupfuura mamwe marudzi ehutachiona hwezvirwere.
Maitiro Amiodarone Anokonzera Utachiona Inotyisa
Amiodarone inokonzera matambudziko ehutano munzira mbiri huru. Chokutanga, amiodarone ine inodha yehuwandu yehudhi, uye kana vamwe vanhu vachidya iodine yakawanda vanogona kukura chirwere chetachiona. Chechipiri, amiodarone inogona kuve yakanyanyisa kuitika pahutachiona gland pachayo (inobereka rudzi rwe thyroiditis), uye zvinodhaka zvinogonawo kuderedza basa remahomoni ehutachiona (kunyanya, inogona kuderedza kutendeuka kweT4 kusvika kuT3, uye inogona kuderedza iyo yokusunga-uye naizvozvo kubudirira-kweT3).
Matambudziko eTyroid Akabudiswa
Amiodarone inogona kubudisa hypothyroidism (utachiona hwehutachiona husingaiti) kana hyperthyroidism. Zvidzidzo zvakasiyana-siyana zvakapa maonero akasiyana-siyana ehuwandu hwezvinetso zvehutori neamayodarone, asi zvinoita sekuti kusvika 30% yevarwere vanobatwa neamododarone vanogona kukura hypothyroidism, uye kusvika 10% inogona kukura hyperthyroidism.
Nemhaka yokuti amiodarone inoramba iri mumuviri kwemwedzi yakawanda (kana kunyange makore) mushure mokunge mishonga ichimira, zvinetso zvehutachiona zvinogona kukura kunyange mushure mokunge amiodarone iregwa uye vanachiremba vanoda kuramba vakangwarira pamusoro peizvi.
Hypothyroidism
Zviratidzo zve hypothyroidism zvinokonzerwa neAmododarone zvakafanana zvikuru nezvinoonekwa nemamwe marudzi e hypothyroidism, uye zvinowanzobatanidza kuneta, kuwedzera kuwanda, kufungidzira, kufungira, kuvhiringidzika, uye kuora mwoyo.
Kuongorora hutachiona hwechirwere muvarwere vanotora amiodarone kunogona kunetsa. Amiodarone inokonzera kukwirira muTSH mazinga munenge wese munhu wese kusvika kumwedzi 6, saka nyanzvi dzinokurudzira kuti tisati tiongororwe maododarone-induced hypothyroidism kusvikira zvaratidzwa kuti mazinga eTSH akakwirira, kana kuti mazinga T4 akaderera. Zvisinei, kana hypothyroidism iripo (kunyange kana iri subclinical hypothyroidism ), zvinokosha kuita kuti kuongororwa kunyanya kune vanhu vane chirwere chepfungwa chepfungwa.
Kurapa amiodarone-induced hypothyroidism inonyanya kufanana nekurapa chero ipi zvayo yemhando ye hypothyroidism (kureva, nemuromo utachiona hweHodmone replacement), asi, zvakare, inogona kunge yakanyanyisa nokuti amiodarone inogona kuchinja kushanda kwehomoni yekemikari. Mune zviitiko zvakawanda, zvakakwirira-kupfuura-zvinowanzoitika zvehutano zvinotsiviwa nemishonga zvinoda kurapa hypothyroid varwere vanotora amiodarone. Nokuda kwechikonzero ichi, vazhinji vevarwere ava vachashumirwa zvakanaka kuona chiitiko chezvechirwere chechikoro chekubatsira kugadzirisa kurapa kwavo.
Hyperthyroidism
Kune maitiro maviri akasiyana ayo ambodarone inokonzera hyperthyroidism. Mune vamwe varwere (avo vane goiters iri pasi, kana kuti neCheves 'Graves' chirwere ), chero kuwedzera kweyodini kunodya kunogona kuita kuti utachiona hutange kubudisa huwandu hwakawanda hwehomoni yehomoni.
Uye kutora amiodarone inopa utachiona nemutoro mukuru weododhi.
Chechipiri, mune vamwe vanhu amiodarone inogona kunge ine chepfu kune utachiona hwehutachiona pachayo, huchiita utachiona hwehutachiona. Mumamiriro ezvinhu aya, kuparadzwa kwetachiona hutachiona kunobudisa huwandu hwehomoni yehutachi muropa. Iyi thyroiditis inopedzisira "inopisa kunze" apo pasina chigadziko chetachiona chakasara kuti chiparadzwe. Murwere anobva ava hypothyroid. Asi panguva ino-panguva ino inogona kugara kwemwedzi kana makore-hyperthyroidism idambudziko.
Kliniki zviratidzo zveAmayodarone-inokonzerwa hyperthyroidism inogona kusiyana ne hyperthyroidism isina kukonzerwa nechirwere ichi.
Nemhaka yokuti amiodarone ine bhe--blocking effect, uye nokuti mishonga inogonawo kuderedza chiito chetachiona hormone, dzakawanda dzezviratidzo zvinoratidza hyperthyroidism (zvakadai sejitteriness, kutya, kushushikana, kutonhora kwemazuva, kana kutuka zvakanyanya), zvakavharwa. Saka chiremba wacho haafaniri kufunga nezvekuongororwa kwaipo pakarepo.
Varwere vane amiodarone-inokonzerwa hyperthyroidism vanowanzove vachiwedzera kukura kwezvirwere zvepfungwa. (Varwere vazhinji vanotora ichi chirwere vari kutora ichi nekuda kwechirwere chepfungwa.) Saka vanowanzowedzera kushaya arhythmias (kazhinji, ma arrhythmias ayo amiodarone akanyorwa pakutanga), kuwedzera kukundikana kwemoyo , kuwedzera zviratidzo zvekodonary artery disease , pasi-grade-grade fever, kana kuora muviri kwechikonzero chisingaoneki. Vanachiremba vasingachenjeri vangasafunga nezvezvinetso zvehutori kana zviratidzo zvakadaro zvichiitika.
Kurapa kwamaodarone-induced hyperthyroid zvirwere kunogona kunge kwakaoma. Thionamide zvinodhaka izvo zvinodzivisa kubatana kwehomoni yehrodhi (yakadai sepropylthiouracil-PTU), inowanzoshandiswa. Perchlorate, iyo inoderedza kuwedzerwa kwe iodine nehutano hwetachiona, inogona kubatsira. Zvisinei, mishonga yemishonga iyi inoda kuderedza kushandiswa kwetachiona hormone inowanzova yakakwirira muvarwere vachitora amiodarone, uye zvinogona kuva zvakaoma kushandisa madhiragi aya zvakanaka. Zvakaipisisa, kana hyperthyroidism inokonzerwa ne-amiodarone-induced thyroiditis, zvinodhaka zvinoshandiswa kuderedza kushandiswa kwehomoni yekemikari kazhinji hazvibatsiri zvachose, uye utachiona hwehutachiona (hurosi hwehutori-kubviswa) ndiyo chete inoshandiswa.
Utachiona hwehurosi neyodacid iodine-ausinvasive nzira inoshanda zvakajeka muchimiro che hyperthyroidism-kazhinji haisi mutsva mumurwere anotora amiodarone. Izvi ndechokuti chirwere chetachiona muvarwere ava chave chakanyanyisa kuwandisa ne iodine kuti hutachiona hunoita kuti iodine inoputika isanyanya kuderera.
Kana hyperthyroidism iri kukonzera kukanganisa kwemwoyo, angina isina kugadzikana , kana kuti zvirwere zvinopisa upenyu, zvinogona kuva dambudziko rekuwana kurapa kwakanaka nokukurumidza sezvinobvira-izvo zvinoitwa zvakaoma zvikuru nekuderedza zvakanyanya kusarudzwa kweutano. Chero zvazvingaitika, kurapa amiodarone-induced hyperthyroidism yakakomba zvakakwana zvokuti nyanzvi yemagariro ekupedzisira inofanirwa kuve yakabatanidzwa nguva dzose.
Pasi Pasi
Matambudziko ehutano anowanzoonekwa nevarwere vanotora amiodarone. Izvi zvinetso zvinogona kuva zvakaoma kuziva, zvakaoma kubata, uye dzimwe nguva zvinogona kutyisidzira upenyu. Zvakakosha kuve wakangwarira kuti zvinetso zvehutachiona zvigone kune ani zvake anotora amiodarone.
Izvo zvinoita kuti utachiona huve nemigumisiro inongova chikonzero chimwe chete chikonzero nei vanachiremba vachifanira kugara vasingadi kuudza amiodarone. Kana vakaona zvakakosha kuita kudaro, saka vanofanira kunzwa vachisungirwa kunyatsotevedzera varwere ava, kwemakore kana zvichidiwa, kuitira kuti vaone nezvehutachiona hwemigumisiro, pamwe chete nedzimwewo migumisiro inowanikwa neichi chirwere.
Sources:
Basaria S, Cooper DS. Amiodarone uye utachiona. Am J Med 2005; 118: 706.
Bogazzi F, Bartalena L, Martino E. Nzira kumurwere ane amiodarone-induced thyrotoxicosis. J Clin Endocrinol Metab 2010; 95: 2529.