以甲腺結節來表現的第二型Amiodarone導致的甲狀腺機能亢進症

Type 2 Amiodarone-induced Thyrotoxicosis Which Presented with Nodular goiter

Amiodarone 是一個碘化的苯丙夫喃(benzofuran) 衍生物，因其具有冠狀動脈擴張的效果，在1960 年代被用來當成抗心絞痛藥物。之後他被廣泛用來當作抗心律不整的藥物。Amiodarone 藥物本身及其會釋放碘，雙雙都會影響甲狀腺的功能。Amiodarone 導致的甲狀腺毒血症 (AIT) 的發生率在大部分的研究當中大約是5-10%。Amiodarone 導致的甲狀腺毒血症有兩種類型，分別是第一型和第二型。第一型AIT 發生在不正常的甲狀腺（甲狀腺結節，潛伏性葛瑞夫 氏症 (Graves’ disease)），第二型 AIT 則發生在正常的甲狀腺。我們這位病人罕見的是以甲狀腺結節來表現的第二型 AIT。

Amiodarone, an iodinated benzofuranic derivative, was introduced in the 1960s as an antianginal agent for its coronary vasodilator property. Later it was broadly applied as an antiarrhythmic agent. Amiodarone affects thyroid function as a result of both iodine release and intrinsic drug properties. The incidence of Amiodarone induced thyrotoxicosis (AIT) is 5-10% in reports of most studies. There are two types of AIT, designated as type 1 and type 2. Type 1 AIT occurs in abnormal thyroid glands (nodular goiter, latent Graves’ disease) and type 2 AIT in apparently normal thyroid glands. But mixed or indefinite form, the combination of these 2 forms does exist. This form maybe caused by both pathogenic mechanisms. Here we reported a patient with type 2 AIT who presented not only with common manifestations of type 1AIT but also gained euthyroid state with steroid therapy.