Almanac of Clinical MedicineAlmanac of Clinical MedicineАльманах клинической медицины2072-05052587-9294Moscow Regional Research and Clinical Institute (MONIKI)100910.18786/2072-0505-2019-47-018REVIEW ARTICLEОБЗОРAmiodarone-induced thyrotoxicosis type 2: predictors and treatment optionsАмиодарон-индуцированный тиреотоксикоз 2-го типа: предикторы и варианты терапииErmolaevaA. S.ЕрмолаеваА. С.
Russian Federation

Alexandra S. Ermolaeva – Postgraduate Student, Department of Endocrinology No. 1, Medical Faculty,

8/2 Trubetskaya ul., Moscow, 119991

Ермолаева Александра Сергеевна – аспирант кафедры эндокринологии № 1 лечебного факультета,

 119991, г. Москва, ул. Трубецкая, 8/2

a.s.arkhipova@inbox.ruBiakinaO. A.БякинаО. А.
Russian Federation

Olga A. Biakina – Postgraduate Student, Department of Preventive and Emergency Cardiology, Medical Faculty,

8/2 Trubetskaya ul., Moscow, 119991

Бякина Ольга Алексеевна – аспирант кафедры профилактической и неотложной кардиологии лечебного факультета,

119991, г. Москва, ул. Трубецкая, 8/2

SytchJ. P.СычЮ. П.
Russian Federation

Julia P. Sytch – MD, PhD, Assistant, Department of Endocrinology No. 1, Medical Faculty,

8/2 Trubetskaya ul., Moscow, 119991

Сыч Юлия Петровна – канд. мед. наук, ассистент кафедры эндокринологии № 1 лечебного факультета,

119991, г. Москва, ул. Трубецкая, 8/2

KopylovP. Yu.КопыловФ. Ю.
Russian Federation

Phillip Yu. Kopylov – MD, PhD, Professor, Department of Preventive and Emergency Cardiology, Medical Faculty,

8/2 Trubetskaya ul., Moscow, 119991

Копылов Филипп Юрьевич – д-р мед. наук, профессор кафедры профилактической и неотложной кардиологии лечебного факультета,

119991, г. Москва, ул. Трубецкая, 8/2

FadeevV. V.ФадеевВ. В.
Russian Federation

Valentin V. Fadeev – MD, PhD, Professor, MemberCorrespondent of Russian Academy of Sciences, Head of Department of Endocrinology No. 1, Medical Faculty,

8/2 Trubetskaya ul., Moscow, 119991

Фадеев Валентин Викторович – д-р мед. наук, профессор, чл.-корр. РАН, заведующий кафедрой эндокринологии № 1 лечебного факультета,

119991, г. Москва, ул. Трубецкая, 8/2

I.M. Sechenov First Moscow State Medical UniversityФГАОУ ВО Первый Московский государственный медицинский университет имени И.М. Сеченова Минздрава России (Сеченовский университет)310520194721561650404201904042019Copyright ©; 2019, Ermolaeva A.S., Biakina O.A., Sytch J.P., Kopylov P.Y., Fadeev V.V.Copyright ©; 2019, Ермолаева А.С., Бякина О.А., Сыч Ю.П., Копылов Ф.Ю., Фадеев В.В.2019Ermolaeva A.S., Biakina O.A., Sytch J.P., Kopylov P.Y., Fadeev V.V.Ермолаева А.С., Бякина О.А., Сыч Ю.П., Копылов Ф.Ю., Фадеев В.В.https://creativecommons.org/licenses/by/4.0https://almclinmed.ru/jour/article/view/1009

Amiodarone-induced type 2 thyrotoxicosis remains a  significant problem of modern endocrinology and cardiology. The unique pharmacological character and multifaceted properties of amiodarone explain its high prescription frequency and the leading position among antiarrhythmic drugs. In its turn, cytotoxicity and supra-physiological iodine content in the drug increase the risk of drug-induced destructive thyroiditis. The development of thyrotoxicosis leads to recurrence of cardiac arrhythmias, increased left ventricular dysfunction and manifestations of chronic heart failure. Correct identification of the type of thyrotoxicosis determines the subsequent patient management strategy. Glucocorticoids have been recognized as the first-line treatment among the possible therapy options. Rapid correction of thyrotoxicosis is crucial, especially in elderly patients with severe heart disease. Of interest for practical medicine is the search for specific predictors (deep understanding of the pathogenetic mechanisms) and new possibilities of therapy for amiodarone-induced thyrotoxicosis type 2.

Амиодарон-индуцированный тиреотоксикоз 2-го типа остается значимой проблемой современной эндокринологии и  кардиологии. Фармакологическая уникальность и многогранность амиодарона объясняют высокую частоту его назначения и лидирующую позицию среди антиаритмических препаратов. В свою очередь, цитотоксичность и  сверхфизиологическое содержание йода повышают риск возникновения лекарственного деструктивного тиреоидита. Развитие тиреотоксикоза приводит к  рецидивам нарушений ритма сердца, нарастанию дисфункции левого желудочка и  проявлений хронической сердечной недостаточности. Точная идентификация типа тиреотоксикоза определяет дальнейшую тактику ведения пациента. Среди возможных вариантов терапии препаратами первой линии признаны глюкокортикоиды. Быстрая коррекция тиреотоксикоза имеет решающее значение, особенно у  пожилых пациентов с тяжелой кардиальной патологией. Интерес для практической медицины представляет поиск специфических предикторов (глубокое понимание механизмов патогенеза) и новых возможностей терапии амиодарон-индуцированного тиреотоксикоза 2-го типа.

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