以多汗為主訴的Amiodarone造成的甲狀腺功能異常：個案報告

Amiodarone-Induced Thyroid Dysfunction Presenting as Hyperhidrosis: A Case Report

Amiodarone在心律不整的個案中是相當常被使用及具療效的藥物，然而，部分個案在使用後會出現甲狀腺功能異常的副作用，尤其在本身有甲狀腺疾患的個案身上更顯著。因此在開立此藥物前須先檢測甲狀腺功能，而當臨床上懷疑甲狀腺功能異常，也需審視有無使用會影響甲狀腺的藥物。本篇病例報告呈現一位以多汗為主訴的高齡男性個案，經病史詢問及檢查後診斷為藥物造成的甲狀腺功能異常，在停藥並追蹤一年後症狀已改善。

A 78-year-old male with history of transient ischemic attack visited our cardiovascular outpatient department due to tachycardia and palpitations. Electrocardiography showed atrial fibrillation (AFib) with rapid ventricular response; amiodarone combined with propranolol was then prescribed for rhythm and rate control. However, after four weeks of medication, the patient developed excessive sweating and heat intolerance, prompting him to visit our family medicine outpatient department. He denied any history of thyroid, endocrine or autoimmune disease. Laboratory evaluation revealed hyperthyroidism (TSH: 0.006μIU/mL, free T4: 1.890 ng/dL), and thyroid sonography showed no abnormality. As amiodarone-induced thyrotoxicosis was suspected, amiodarone was discontinued and replaced with dronedarone. When returning to the clinic two months later, the patient reported improvement in sweating but new-onset fatigue. Follow-up laboratory results indicated hypothyroidism (TSH: 16.000μIU/mL, free T4: 0.754 ng/dL) and a positive anti-thyroid peroxidase antibody (anti-TPO: 173 IU/mL). Levothyroxine treatment was prescribed. After seven weeks of treatment, thyroid function normalized with complete resolution of both sweating and fatigue. normalized with complete resolution of both sweating and fatigue.