胺碘酮致飞行员甲状腺功能异常二例并文献复习  

Two cases of pilots with amiodarone-induced thyroid dysfunction and literature review

作　　者：杨彩哲[1] 于亚静[1] 徐先荣[1] 郑军[1] 刘红巾[1] 付兆君[1] 崔丽[1] 关小宏[1] 王建昌[1] 

机构地区：[1]空军总医院,北京100142

出　　处：《中华航空航天医学杂志》2015年第2期113-118,共6页Chinese Journal of Aerospace Medicine

基　　金：基金项目：全军“十二五”后勤科研重大项目（AKJ11J004）

摘　　要：目的 总结飞行人员因心律失常服用胺碘酮而引起甲状腺功能异常的临床特征、诊断、分型、治疗及预后,为以后类似疾病的诊治及航空医学鉴定提供经验. 方法 通过回顾性分析2例飞行员因心房颤动服用胺碘酮而引起甲状腺功能异常的过程,结合文献复习,总结胺碘酮诱发甲状腺功能异常的临床特征、诊断、分型、治疗及转归. 结果 例1飞行员在服用胺碘酮7个月后停药,停药1个月后出现“低T3综合征”.停药2年后再次服用胺碘酮,1个月后出现碘诱导2型甲状腺毒症;停用胺碘酮3个月,甲状腺功能恢复正常.例2飞行员间断服用胺碘酮9年后诊断为碘诱导甲状腺功能减退,停用胺碘酮,并口服左甲状腺素钠75 μg,1次/d,补充治疗,5个月后甲状腺功能恢复正常.应用左甲状腺素钠2年后停药,甲状腺功能完全恢复正常.两例飞行员鉴定结论为暂时飞行不合格. 结论 飞行人员应用胺碘酮前,应完善相关检查.在治疗过程中、停药后6～9月甚至更长时间内,应定期检查甲状腺功能.对服用胺碘酮的飞行员要定期随访,尤其对既往存在甲状腺疾病和存在危险因素者.胺碘酮所引起的甲状腺功能异常有可能恢复正常.鉴定结论要结合心律失常和甲状腺功能情况综合判断.Objective To summarize the clinic feature,diagnosis,treatment,and prognosis of amiodarone-induced thyroid dysfunction in the pilots with arrhythmia and gather the experiences on treatment and aviation medical assessment.Methods Retrospective analysis was done on the process of 2 cases with amiodarone induced abnormal thyroid function in pilots with atrial fibrillation and on the literatures to summary the clinic feature,diagnosis,treatment,and prognosis were reviewed.Results Case 1 had taken amiodarone for 7 months and low T3 syndrome was diagnosed 1 month later.Two years later,he took amiodarone again for 1 month and was induced type 2 thyrotoxicosis iodine.After he stopped taking amiodarone for 3 months his thyroid function returned to normal.Case 2 was diagnosed iodine induced hypothyroidism after intermittent taking amiodarone for 9 years.The patient changed to the treatment with 75 ag levothyroxine daily for 5 months and his thyroid function was in normal.By 2-year levothyroxine treatment his thyroid function completely recovered.Aviation medical assessment of two pilots is temporary dlisqualified as arrhythmias.Conclusions The thyroid related examination is necessary before taking amiodarone.In the treatment of amiodarone,or after withdrawal for 6-9 months or even longer,the regular follow-up is suggested,especially for the patients with thyroid diseases history and with risk factors.Amiodarone-induced abnormal thyroid function could be treated.The aviation medical assessment should be concerned arrhythmias and thyroid function.

关 键 词：胺碘酮 甲状腺毒症 甲状腺功能减退症 治疗结果 飞行员 

分 类 号：R85[医药卫生—航空、航天与航海医学]