Amiodarone waa daawada ugu haboon ee daawada ka hortagta antiarrhythmic kaas oo waligiis loo sameeyay. Nasiib darro, sidoo kale waa sunta ugu xun.
Dhibaatooyinka badan ee la arko amiodarone, cudurada thyroid ayaa ah kuwa ugu badan. Cudurka tiyootiga ee amiodarone-ku wuxuu sababi karaa natiijo taas oo adkaan karta in la aqoonsado. Intaas waxaa sii dheer, xanuunada thyroid-ka ee amiodarone-ka ah ayaa inta badan adagtahay in lagu daweeyo noocyada kale ee cudurada thyroid.
Sidee Amiodarone wuxuu u keenaa sunta qanjidhka
Amiodarone waxay keentaa dhibaatooyin qanjirro ah laba siyaabood oo waaweyn. Ugu horreyn, amiodarone waxay leedahay waxyaabo iodine ah oo aad u sarreeya, iyo marka dadka qaar ay u rogaan xaddi badan oo iodine ah waxay ku dhici karaan cudurka thyroid. Marka labaad, amiodarone waxay yeelan kartaa saameyn toos ah oo ku saabsan qanjidhka thyroid laftiisa (oo soo saaro nooc ka mid ah thyroiditis), daroogada ayaa sidoo kale hoos u dhigi karta hawsha hoormoonka tayroodhka (gaar ahaan, wuxuu yareeyn karaa isbedelka T4 ilaa T3, wuxuuna yarayn karaa qabashada-iyo sidaas darteed waxtarka-ee T3).
Dhibaatooyinka Dhibaatada ee La Soo saaro
Amiodarone wuxuu soo saari karaa hypothyroidism (thyroid fir-fir fircoon) ama hyperthyroidism (qanjidhka firfircoon ee firfircoon). Daraasado kala duwan ayaa qiyaaso kala duwan oo ku saabsan inta jeer ee dhibaatada thyroid la leh amiodarone, laakiin waxay u muuqataa in ilaa 30% bukaannada lagu daweeyo amiodarone ay ku dhici karaan hypothyroidism, ilaa 10% waxay ku dhici karaan hyperthyroidism.
Sababtoo ah amiodarone weli jidhka bilo badan (ama xitaa sanado) ka dib markii daroogada la joojiyo, dhibaatooyinka qanjidhada ayaa dhici karta xitaa ka dib markii amiodarone la joojiyo iyo dhakhaatiirtu waxay u baahan yihiin inay isha ku hayaan fursadan.
Hypothyroidism
Calaamadaha cudurka hypothyroidism ee ay keento amiodarone waxay aad u la mid yihiin kuwa lagu arkay noocyada kale ee hypothyroidism, waxaana badanaa ku jira daal, miisaanka koritaanka, fekerka suuxinta, bararka, caloosha, iyo niyadjabka.
Baaritaanka hypothyroidism ee bukaanada qaadata amiodarone waxay noqon kartaa dhibaato. Amiodarone wuxuu keenaa kor uqaadis heerarka TSH ee qof kasta ilaa 6 bilood, sidaas darteed khubarada ayaa kugula talinaya in aan lagu ogaan cudurka hypothyroidism amiodarone ilaa iyo inta la muujinayo in heerarka sare ee TSH ay sii socoto, ama heerka T4 uu hooseeyo. Si kastaba ha noqotee, haddii uu jiro cudurka hypothyroidism (xitaa haddii uu yahay hypotyroidism subclinical ), waxaa muhiim ah in la sameeyo baaritaanka gaar ahaan dadka qaba cudurka wadnaha ee hooseeya.
Daaweynta cudurka hypothyroidism amiodarone wuxuu ku salaysan yahay sida daaweynta nooc kale oo ah hypothyroidism (taas oo ah, iyada oo la isticmaalayo beddelidda hormoonka thyroid-ka ee afka), laakiin, mar kale, waxay noqon kartaa mid khafiif ah sababtoo ah amiodarone waxay bedeli kartaa waxtarka hoormoonka tayroodhka. Xaalado badan, qiyaasta daaweynta nukliyerka ah ee ka sareeya kuwa caadiga ah ayaa looga baahan yahay inay daaweeyaan bukaannada qaba hypothyroid oo qaadanaya amiodarone. Sababtan awgeed, bukaan badan oo bukaan ah ayaa si wanaagsan loogu adeegi doonaa si ay u arkaan khibrad khibrad leh oo ku takhasusay daaweynta khibradahooda.
Hyperthyroidism
Waxaa jira laba hab oo kala duwan oo amiodarone uu sababo hyperthyroidism. Bukaanjiifka qaar (kuwa leh cirbadaha hooseeya, ama calaacalaha qallalan ), wax kasta oo korodh ah ee cuncunka iodine waxay sababi kartaa tayroodhka inay bilaabaan soo saarista xaddi xad-dhaaf ah oo hoormoonka tayroodhka ah.
Qaadashada amiodarone wuxuu soo bandhigaa dheef-shiid kiimikaad leh xabbad jilicsan oo aad u ballaaran.
Marka labaad, dadka qaarkiis amiodarone waxay noqon karaan sun ku ah unugyada thyroid lafta lafteeda, taasoo keenta thyroiditis burbur. Xaaladdan, burburinta unugyada thyroid ayaa sii deynaya xaddi badan oo hoormoonka tayroodhka ku jira dhiigga. Taabashadani waxay ugu dambeyn "u gubtaa" marka aysan jirin wax nuduc ah oo la tirtiro si loo baabi'iyo. Dabadeed bukaanka ayaa noqda hypothyroid. Laakiin marka la eego wakhtigaas oo socon kara muddo bilo ama sannado ah - hyperthyroidism waa dhibaatada.
Tilmaamaha kiliinikada ee amiodarone-ku-oogista hyperthyroidism way ka duwanaan kartaa hyperthyroidism oo aan sababin daroogadan.
Sababtoo ah amiodarone waxay leedahay saameyn beta-blocking , iyo sababta oo ah daroogada ayaa sidoo kale hoos u dhigi kara tallaabada hoormoonka thyroid, badanaa calaamadaha caadiga ah ee hyperthyroidism (sida jeexitaan, dareen, walaac, dareenka kulaylka, ama dhidid badan), waa masked. Sidaas awgeed dhaqtarka ayaa laga yaabaa inaanay ka fekerin dhakhtarka isla markiiba.
Bukaan-socodka leh amiodarone-ku-dallaca hyperthyroidism waxay u badan tahay in ay la kulmaan xumaan calaamadaha wadnaha. (Bukaanno badan oo qaata daroogadaan ayaa qaadaya sababtoo ah cudurka wadnaha ee hoose.) Sidaa awgeed marar badan way ka sii daraan arrinthias (badanaa, arrin ku haboon amiodarone ayaa loo qoray meeshii ugu horeysay), ka sii darista wadnaha oo aan fiicnayn , calaamadaha sii xumaanaya ee cudurka cillad wadnaha , qandho hoose, ama miisaan lumis la'aanta sabab la'aan. Dhakhaatiirta aan feejignaanta lahayn waxa laga yaabaa inaanay ka fekerin dhibaatooyinka qanjidhada marka ay astaamuhu horumaraan.
Daaweynta amiodarone-ku-dillaacsan cudurada hyperthyroid waxay noqon kartaa mid aad u dhib badan. Daawooyinka Thionamide ee xannibaya astunka hoormoonka tayroodhka (sida propylthiouracil-PTU), ayaa badanaa la isticmaalaa. Perchlorate, taas oo hoos u dhigta kor u kaca ee iodine by qanjirka thyroid, ayaa laga yaabaa inay caawiso. Si kastaba ha noqotee, qiyaasaha daawooyinkan loo baahan yahay si loo yareeyo wax soo saarka hoormoonka tayroodhka badanaa waa mid aad u sarreeya ee bukaanada qaata amiodarone, waxayna noqon kartaa caqabad ku ah isticmaalka daawooyinkan si waxtar leh. Waxaa sii xumaanaya, haddii hyperthyroidism ay keento thyroiditis-amiodarone-sababtoo ah thyroiditis, daawooyinka loogu talagalay hoos u dhigida wax soo saarka hoormoonka tayroodhka sida caadiga ah ma shaqeeyaan dhammaantood, oo ah thyroidectomy (qalliinka tirtiridda qalliinka) waa kelida kaliya.
Qanjirka 'thyroid' ee leh xayawaan raadiyaha ah - hab aan habooneyn oo si fiican u shaqeynaya hyperthyroidism-caadi ahaan maaha ikhtiyaarka bukaanka qaadanaya amiodarone. Sababtoo ah qanjirka thyroid ee bukaankan ayaa horayba u badiyay iodine in kor u kaca tayroodhka shucaaca ee shucaaca firfircooni aad u yaraaday.
Haddii hyperthyroidism uu keeno wadnaha oo aan shaqeynaynin, angina xasiloon , amaba noloshu khatar galinayso, waxay noqon kartaa xaalad deg-deg ah oo lagu gaaro daaweyn wax ku ool ah sida ugu dhakhsaha badan - taas oo ka dhigtay mid aad ugu adkaatay doorashooyin daaweyneed oo aad u yar. Xaalad waliba, daaweynta hyperthyroidism amiodarone waa mid aad u adag oo ku filan in dhakhtar takhasus leh oo ku takhasusay dhakhtarka qaliinka waa inuu had iyo jeer ku lug yeeshaa.
Khadka hoose
Xanuunada qanjirada ayaa ku badan bukaanada qaata amiodarone. Dhibaatooyinkaas way adkaan karaan in la aqoonsado, adagtahay in la daweeyo, mararka qaarkoodna waxay noqon karaan nolol halis ah. Waa muhiim inaad u feejignaato suurtogalnimada dhibaatooyinka tayroodhka qof kasta oo qaadanaya amiodarone.
Awoodda waxyeelada thyroid-ka ayaa ah hal sabab kale oo ay tahay in dhakhtarradu marwalba u diidaan inay qoraan amiodarone. Haddii ay u arkaan inay muhiim tahay in sidaas la sameeyo, markaa waa inay dareemaan inay waajib ku tahay inay si taxadar leh u raacaan bukaankan, sanado haddii ay lagama maarmaan noqoto, si ay ula socdaan saamaynta daaweynta thyroid, iyo sidoo kale dhammaan saameynta daawooyinka kale ee la arko.
Ilaha:
Basaria S, Cooper DS. Amiodarone iyo qanjidhada. Am J Med 2005; 118: 706.
Bogazzi F, Bartalena L, Martino E. U dhowaanshaha bukaanka qaba thyrotoxicosis amiodarone. J Clin Endocrinol Metab 2010; 95: 2529.