Features of the structural and functional condition of the thyroid gland in patients with coronary heart disease and amiodarone-associated thyroiditis

Background. Coronary heart disease (CHD) is one of the most urgent problems of modern medicine. Heart rhythm disorders are frequent complications of the disease that determine its unfavorable prognosis. Amiodaron currently regarded as one of the most efficient and safe antiarrhythmic drugs. Changes in the structural and functional state of the thyroid system (TS) is one of the factors in the development of amiodarone-associated conditions in patients with coronary heart disease. Objective. To assess structural and functional features of thyroid gland in patients with coronary artery disease who developed amiodarone-associated thyrotoxicosis (AAT). Methods. There were studied the case histories of 530 patients with CHD who received amiodarone for various heart rhythm disorders. In the future, a retrospective study of TS was conducted in 40 patients with AAT. Results. It was developed in patients with CHD, AAT in 8.1% of cases. 93.2% of the examined patients were diagnosed with a manifest form of the disease, while men developed AAT significantly more often (68.3%). In most cases (77.2%), patients with CHD who took amiodarone the first type of AAT was developed. Various thyroid diseases were diagnosed in 32 (74.4%) patients with developed AAT during 6.2±1.1 years before the development of thyroid disease. In a retrospective analysis, all patients with CHD were diagnosed with euthyroidism. At the same time, the level of thyroid-stimulating hormone in patients with coronary heart disease with subsequent AAT was 18.8% significantly lower (p<0.05) than in the comparison group. The titer of antibodies to thyroperoxidase and thyroglobulin was increased in all subjects. In the examined main group, it was 79.2% significantly higher (p<0.05) in comparison with other patients. Nodular formations in the structure of the thyroid gland were observed in 25 (62.5%) of the examined main group. In the comparison group, similar changes in the thyroid were found in 22.2% of cases. The most common cystic formations in the structure of the thyroid gland were also observed in patients with CHD with AAT (20%). In the comparison group, they were determined only in 3 patients (8.3%). The number of patients with calcifications in the structure of the thyroid gland was insignificant and did not differ significantly from each other in each group of patients - 3 (7.5%) and 2 (5.5%). Conclusion. In patients with CHD with developed AAT, the structural and functional condition of the thyroid gland is characterized by a long history of various pathology of the gland, its pronounced structural changes, as well as an increase in the titer of autoantibodies to thyrocytes.

coronary heart disease, heart rhythm disorders, thyroid status, amiodarone-associated thyrotoxicosis