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Totale Thyreoidektomie bei amiodaroninduzierter Hyperthyreose

Wann übersteigt das Risiko der konservativen Therapie das Risiko der chirurgischen Behandlung?

Total thyroidectomy in patients with amiodarone-induced hyperthyroidism

When does the risk of conservative treatment exceed the risk of surgery?

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Zusammenfassung

Amiodaron ist eine wichtige medikamentöse Option zur Behandlung ventrikulärer und supraventrikulärer Arrhythmien. Die amiodaroninduzierte Hyperthyreose (AIH) ist eine gefürchtete Komplikation, welche eine interdisziplinäre Behandlung und ein sorgfältiges Abwägen der Risiken einer konservativen Therapie gegen das Risiko einer totalen Thyreoidektomie erfordert. In diesem Beitrag beleuchten wir die pharmakologischen Grundlagen des Amiodarons und seine vielfältigen Effekte auf die Schilddrüse. Neben Überlegungen zur Diagnostik und zu den Therapieoptionen berichten wir anhand einer Fallserie von unseren positiven Erfahrungen mit der totalen Thyreoidektomie bei AIH. Insbesondere für Patienten, welche zwingend auf eine Weiterführung der Amiodarontherapie angewiesen sind, stellt die Thyreoidektomie bei gutem Timing eine rasche und zuverlässige Behandlung der AIH mit geringen Komplikationsraten und einer sofortigen Verbesserung der Symptomatik dar.

Abstract

Amiodarone plays a pivotal role in the treatment of ventricular and supraventricular arrhythmias. However, amiodarone-induced hyperthyroidism (AIH) is one of the most feared complications, which necessitates interdisciplinary treatment and careful balancing of the risks of conservative treatment against those of total thyroidectomy. In this article we discuss the pharmacological aspects of amiodarone and its diverse effects on the thyroid. Furthermore, we present diagnostic and therapeutic strategies and report our positive experiences with total thyroidectomy in patients with AIH. Particularly in patients for whom continuation of amiodarone treatment is compulsory, a well-timed total thyroidectomy is a reliable therapeutic option, with minimal complication rates and immediate amelioration of symptoms.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. C. Meerwein, D. Vital, M. Greutmann, C. Schmid und G.F. Huber geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Klinik für Ohren-, Nasen-, Hals- und Gesichtschirurgie, Universitätsspital Zürich, Frauenklinikstr. 24, 8091, Zürich, Schweiz

    C. Meerwein, D. Vital &  G.F. Huber

  2. Klinik für Kardiologie, Universitätsspital Zürich, Zürich, Schweiz

    M. Greutmann

  3. Klinik Endokrinologie und Diabetologie, Universitätsspital Zürich, Zürich, Schweiz

    C. Schmid

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  1. C. Meerwein
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  2. D. Vital
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  3. M. Greutmann
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  4. C. Schmid
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  5. G.F. Huber
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Correspondence to G.F. Huber.

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Meerwein, C., Vital, D., Greutmann, M. et al. Totale Thyreoidektomie bei amiodaroninduzierter Hyperthyreose. HNO 62, 100–105 (2014). https://doi.org/10.1007/s00106-013-2806-0

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