Amiodarone ndi mankhwala osokoneza bongo omwe amagwira ntchito kwambiri. Mwatsoka, imakhalanso ndi poizoni kwambiri.
Pa mavuto ambiri omwe amapezeka ndi amiodarone, vuto la chithokomiro ndilofala kwambiri. Matenda a chithokomiro a Amiodarone akhoza kukhala ofunika kwambiri ndipo angakhale ovuta kuzindikira. Kuwonjezera apo, matenda a chithokomiro omwe amachititsa azimayi omwe amachititsa kuti asokonezeke ndi matenda a chithokomiro amakhala ovuta kwambiri kuposa matenda ena a chithokomiro.
Momwe Amiodarone Imayambitsa Kachilombo Toxicity
Amiodarone imayambitsa mavuto a chithokomiro m'njira zikuluzikulu ziwiri. Choyamba, amiodarone ali ndi mavitamini apamwamba kwambiri, ndipo pamene anthu ena amamwa kwambiri ayodini amatha kukhala ndi matenda a chithokomiro. Chachiwiri, amiodarone ikhoza kukhala yoopsa kwambiri pa chithokomiro chokha (kutulutsa mtundu wa thyroiditis), ndipo mankhwalawa akhoza kuchepetsa mphamvu ya mahomoni a chithokomiro (makamaka, akhoza kuchepetsa kutembenuka kwa T4 mpaka T3, ndipo akhoza kuchepetsa kumangiriza-ndipo motero mphamvu-ya T3).
Matenda a Chithokomiro Anapangidwa
Amiodarone ikhoza kutulutsa hypothyroidism (chithokomiro chosagwira ntchito) kapena hyperthyroidism (chithokomiro chogwira ntchito kwambiri). Kafukufuku wina wapereka zosiyana zosiyana za mavuto omwe amapezeka pa chithokomiro ndi amiodarone, koma zikuwoneka kuti mpaka oposa 30% a odwala ndi amiodarone akhoza kupanga hypothyroidism, ndipo mpaka 10% akhoza kukhala hyperthyroidism.
Chifukwa amidodarone amakhalabe m'thupi kwa miyezi yambiri (kapena ngakhale zaka) mutatha mankhwalawa, mavuto a chithokomiro amatha ngakhale pambuyo poti amiodarone yatha ndipo madokotala ayenera kukhala osamala potsata izi.
Hypothyroidism
Zizindikiro za hypothyroidism zomwe zimayambitsidwa ndi amiodarone zimakhala zofanana ndi zomwe zimawonedwa ndi mitundu ina ya hypothyroidism, ndipo kawirikawiri zimaphatikizapo kutopa, phindu lolemera, kuganiza mozama, kutupa, kudzimbidwa, ndi kuvutika maganizo.
Kuzindikira odwala hypothyroidism odwala omwe amatha kukhala amiodarone akhoza kukhala wonyenga. Amiodarone imayambitsa kukwera m'misinkhu ya TSH pafupifupi aliyense kwa miyezi 6, kotero akatswiri amalimbikitsa kuti asamadziwe kuti mankhwala a hypothyroidism amachititsa kuti azimayi asagarone atsimikizidwe mpaka kuti zisonyezero za TSH zikupitirirabe, kapena kuti ma T4 ali otsika. Komabe, ngati hypothyroidism ilipo (ngakhale ngati subclinical hypothyroidism ), ndikofunika kupanga matendawa makamaka kwa anthu omwe ali ndi matenda a mtima.
Kuchiza mankhwala otchedwa amiodarone-hypducedroidism ndizofanana ndi kuchiza mtundu wina uliwonse wa hypothyroidism (ndiko kuti, pakamwa pamatenda a chithokomiro m'malo mwake), koma, kachiwiri, zingakhale zovuta chifukwa amamodarone angathe kusintha mahomoni a chithokomiro. Nthaŵi zambiri, mankhwala oposa athanzi omwe amawotcha mankhwala a chithokomiro amafunika kuti athe kuchiza odwala hypothyroid omwe amatenga amiodarone. Pachifukwa ichi, ambiri mwa odwalawa adzatumikiridwa kuti awonetsere katswiri wodziwa bwino matendawa kuti athetse chithandizo chawo.
Hyperthyroidism
Pali njira ziwiri zosiyana zomwe amiodarone zimayambitsa hyperthyroidism. Odwala ena (omwe ali ndi mazira oyenda pansi, kapena ndi Matenda Akumbuyo ), kuwonjezeka kulikonse kwa ayodini kumalowa kungachititse kuti chithokomiro chiyambe kupanga mahomoni ambiri a chithokomiro.
Ndipo kutenga amiodarone kumayambitsa chithokomiro ndi katundu weniweni wa ayodini.
Chachiwiri, mwa anthu ena amiodarone akhoza kukhala poizoni kwa matenda a chithokomiro, ndipo amapanga chithokomiro chowononga. Pachikhalidwe ichi, kuwonongeka kwa minofu ya chithokomiro kumatulutsa mahomoni ambiri a chithokomiro m'magazi. Katemera wotchedwa "thyroiditis" amatha "kudziwotcha" pamene palibe mankhwala a chithokomiro otsalira kuti awonongedwe. Wodwala ndiye amakhala hypothyroid. Koma pakalipano-pakali pano yomwe ikhoza kukhala kwa miyezi kapena zaka-hyperthyroidism ndi vuto.
Mawonetseredwe a kachipatala a hymidthyroidism omwe amachititsa kuti azimodarone asinthidwe akhoza kusiyana ndi hyperthyroidism osati chifukwa cha mankhwalawa.
Chifukwa chakuti amidodarone amachititsa kuti tizilombo toyambitsa matenda tizilombo toyambitsa matenda tizilombo toyambitsa matenda, komanso chifukwa mankhwalawa amachepetsanso kachilombo ka chithokomiro, zizindikiro zambiri za hyperthyroidism (monga kutaya, mantha, nkhawa, kutentha kwa dzuwa, kapena kutukuta kwambiri), zimasokonezeka. Kotero dokotalayo sangaganize za matendawa pomwepo.
Odwala omwe ali ndi amiodarone-omwe amachititsa hyperthyroidism amakhala odwala kwambiri. (Odwala ambiri omwe amamwa mankhwalawa akuwutenga chifukwa cha matenda a mtima.) Choncho nthawi zambiri amatha kuwonjezereka kwambiri (nthawi zambiri, arrhythmias omwe amiodarone amalembedwa poyamba), kuwonjezereka mtima kulephera , kuwonjezereka kwa zizindikiro za matenda a mitsempha , kutentha kwa malungo, kapena kulemera kwake popanda chifukwa chomveka. Madokotala omwe sali maso sangaganize za vuto la chithokomiro pamene zizindikirozo zimayamba.
Chithandizo cha matenda a hyperthyroid a amiodarone angakhale ovuta kwambiri. Mankhwala a Thionamide omwe amachititsa kuti mahomoni a chithokomiro (synthesis propylthiouracil-PTU) asagwiritsidwe ntchito nthawi zambiri amagwiritsidwa ntchito. Perchlorate, yomwe imachepetsa kuyambiranso kwa ayodini ndi chithokomiro, zingakhale zothandiza. Komabe, mlingo wa mankhwalawa kuti uchepetse kutulutsa timadzi timene timatulutsa kachilombo kawirikawiri kumakhala kovuta kwambiri kwa odwala kutenga amiodarone, ndipo zingakhale zovuta kugwiritsa ntchito mankhwalawa mogwira mtima. Choipa kwambiri, ngati hyperthyroidism imayamba chifukwa cha chithokomiro chotchedwa amiodarone, mankhwala osokoneza bongo amachititsa kuchepetsa kupanga mahomoni a chithokomiro kawirikawiri sagwira ntchito konse, ndipo chithokomiro (kutsegula chithokomiro-kuchotsa) ndicho chokhacho chimagwiritsidwa ntchito.
Kuperekera kwa chithokomiro ndi ayodini owononga mphamvu-njira yosagwira ntchito yomwe imagwira ntchito mofanana ndi hyperthyroidism-sizingatheke kuti wodwalayo atenge amiodarone. Izi ndi chifukwa chakuti matenda a chithokomiro mwa odwalawa atha kale kwambiri ndi ayodini kuti chiwombankhanga chimasokoneza kwambiri ayodini.
Ngati hyperthyroidism ikuyambitsa mtima, angina wosakhazikika , kapena arritthmias owopseza moyo, zingakhale zosavuta kupeza chithandizo mwamsanga momwe zingathere-zomwe zimavuta kwambiri chifukwa cha kuchepetsa kuchepa kwa mankhwala. Mulimonsemo, chithandizo cha amiodarone-chopangidwa ndi hyperthyroidism ndi chovuta kuti katswiri wamaphunziro a sayansi yamagulu azikhala pafupi nthawi zonse.
Pansi
Matenda a chithokomiro amapezeka mwa odwala omwe amatenga amiodarone. Matendawa angakhale ovuta kuzindikira, ovuta kuchiza, ndipo nthawi zina akhoza kuopseza moyo. Ndikofunika kukhala tcheru chifukwa cha vuto la chithokomiro kwa aliyense amene amatenga amiodarone.
Zomwe zingayambitse mavuto a chithokomiro ndi chifukwa chimodzi chokha chimene madokotala ayenera nthawi zonse kukhala osayenerera kupereka mayodarone. Ngati akuwona kuti ndi kofunikira, ndiye kuti ayenera kuwona kuti akutsatira odwalawa mosamala, kwa zaka zambiri ngati kuli kofunika, kuti awone zotsatira za zotsatira za chithokomiro, komanso zotsatira zina zonse zomwe zimawonedwa ndi mankhwalawa.
Zotsatira:
Basaria S, Cooper DS. Amiodarone ndi chithokomiro. Am J Med 2005; 118: 706.
Bogazzi F, Bartalena L, Martino E. Njira kwa wodwala ndi amiodarone-induced thyrotoxicosis. J Clin Endocrinol Metab 2010; 95: 2529.