Amiodarone-induced thyrotoxicosis

Erdogan ME, Gulec S, Tutar E, Baskal N, Erdogan G (2003) A stepwise approach to the treatment of amiodarone-induced thyrotoxicosis. Thyroid 13 205-209... 

Two patients with cardiomyopathy and resistant dysrhythmias developed thyrotoxicosis while taking amiodarone (71). Despite medical therapy, they failed to improve. Both underwent total thyroidectomy without difficulty or complications. Most reported cases of amiodarone-induced thyrotoxicosis that have been treated surgically have been of type II, i.e. with no underlying thyroid disease. 

The antithyroid effect of lithium has occasionally been used to benefit patients. In a case of amiodarone-induced thyrotoxicosis that did not respond to antithyroid drugs and glucocorticoids, low-dose lithium normalized thyroid function (62). 

Wong R, Cheung W, Stockigt JR, Topliss DJ. Heterogeneity of amiodarone-induced thyrotoxicosis evaluation of colour-flow Doppler sonography in predicting therapeutic response. Intern Med J 2003 33 420-6. 

Bartalena L, Wiersinga WM, Tanda ML, Bogazzi F, Piantanida E, Lai A, Martino E. Diagnosis and management of amiodarone-induced thyrotoxicosis in Europe results of an international survey among members of the European Thyroid Association. Clin Endocrinol (Oxf) 2004 61(4) 494-502. 

Dietlein M, Schicha H. Amiodarone-induced thyrotoxicosis due to destructive thyroiditis therapeutic recommendations. Exp Clin Endocrinol Diabetes 2005 113(3) 145-51. 

Boeving A, Cubas ER, Santos CM, Carvalho GA, Graf H. [Use of lithium carbonate for the treatment of amiodarone-induced thyrotoxicosis.] Arq Bras Endocrinol Metabol 2005 49(6) 991-5. 

Diamond TH, Rajagopal R, Ganda K, Manoharan A, Luk A. Plasmapheresis as a potential treatment option for amiodarone-induced thyrotoxicosis. Intern Med J 2004 34(6) 369-70. 

Hermida JS, Tcheng E, Jarry G, Moullart V, Arlot S, Rey JL, Delonca J, Schvartz C. Radioiodine ablation of the thyroid to prevent recurrence of amiodarone-induced thyrotoxicosis in patients with resistant tachyarrhythmias. Europace 2004 6(2) 169-74. 

Kloos RT. Can amiodarone be restarted after amiodarone-induced thyrotoxicosis Thyroid... 

Franzese CB, Fan CY, Stack BC. Surgical management of amiodarone-induced thyrotoxicosis. Otolaryngol Head Neck Surg 2003 129 565-70. 

Williams M, Lo Gerfo P. Thyroidectomy using local anesthesia in critically ill patients with amiodarone-induced thyrotoxicosis a review and description of the technique. Thyroid 2002 12(6) 523-5. 

Dickstein G, Shechner C, Adawi F, Kaplan J, Baron E, Ish-Shalom S. Lithium treatment in amiodarone-induced thyrotoxicosis. Am J Med 1997 102(5) 454-8. 

That amiodarone can potentiate the action of warfarin by inhibiting its metabolism is well known (SEDA-11, 156). However, potentiation of the action of warfarin has been attributed to amiodarone-induced thyrotoxicosis (264). A metabolic interaction in this case was unlikely, because the patient had taken both drugs together for 2 years before the increase in response to warfarin, coincident with the emergence of thyrotoxicosis. 

Leung PM, Quinn ND, Belchetz PE. Amiodarone-induced thyrotoxicosis not a benign condition. Int J Clin Pract 2002 56(l) 44-6. 

Eaton SE, Euinton HA, Newman CM, Weetman AP, Bennet WM. Clinical experience of amiodarone-induced thyrotoxicosis over a 3-year period role of colour-flow Doppler sonography. Clin Endocrinol (Oxf) 2002 56(l) 33-8. 

Bogazzi F, Bartalena L, Brogioni S, Mazzeo S, Vitti P, Burelli A, Bartolozzi C, Martino E. Color flow Doppler sonography rapidly differentiates type I and type II amiodarone-induced thyrotoxicosis. Thyroid 1997 7(4) 541-5. 

Marketou ME, Simantirakis EN, Manios EG, Vardas PE. Electrical storm due to amiodarone induced thyrotoxicosis in a young adult with dilated cardiomyopathy thyroidectomy as the treatment of choice. Pacing Clin Electrophysiol 2001 24(12) 1827-8. 

Daniels GH. Amiodarone-induced thyrotoxicosis. J Qin Endocrinol Metab 2001 86(l) 3-8. 

Bogazzi F, Aghini-Lombardi F, Cosci C, Lupi I, Santini F, Tanda ML, Miccoli P, Basolo F, Pinchera A, Bartalena L, Braverman LE, Martino E. Lopanoic acid rapidly controls type 1 amiodarone-induced thyrotoxicosis prior to thyroidectomy. J Endocrinol Invest 2002 25(2) 176-80. 

Osman F, Franklyn JA, Sheppard MC, Gammage MD. Successful treatment of amiodarone-induced thyrotoxicosis. Circulation 2002 105(ll) 1275-7. 

Sutherland J, Robinson B, Delbridge L. Anaesthesia for amiodarone-induced thyrotoxicosis a case review. Anaesth Intensive Care 2001 29(l) 24-9. 

Woeber KA, Warner I. Potentiation of warfarin sodium by amiodarone-induced thyrotoxicosis. West J Med 1999 170(1) 49-51. 

Bogazzi F, Bartalena L, Cosci C, et al. Treatment of type 11 amiodarone-induced thyrotoxicosis by either iopanoic acid or glucocorticoids A prospective, randomized study. J Clin Endocrinol Metab 2003 88 1999-2002. 

Among the types of thyroid dysfunction induced by such pharmaceuticals, hypothyroidism in the fetus or neonate and amiodarone-induced thyrotoxicosis (AIT) are severe problems. 

The INR of a patient stabilised on warfarin and amiodarone was noted to increase from about 2 to 5.5 after he developed amiodarone-induced thyrotoxicosis. Another 3 well-described cases of this potential interaction have been reported. ... 

In patients stabilised on warfarin and amiodarone, the possibility of amiodarone-induced thyrotoxicosis should be considered if an abrupt increase in INR occurs. ... 

Endocrine Amiodarone-induced thyrotoxicosis has been reported in three young people a 6-year-old boy with type I amiodarone-induced thyrotoxicosis, a 17-year-old girl with type II, and a 14-year-old girl with a mixed type [41 ]. 

The management of amiodarone-induced thyrotoxicosis has been extensively reviewed [42 ]. For type 1 thyrotoxicosis, thionamides are the best treatment (possibly associated with potassium perchlorate) for type 2, glucocorticoids are the treatment of choice. However, if rapid restoration of euthyroidism is necessary, a short course of iopanoic acid followed by total thyroidectomy is an option. Radioactive iodine has a marginal role. The authors addressed some important controversies, practical problems, and unanswered questions. 

Hacihamdioglu B, Berberoglu M, Siklar Z, Sava Erdeve S, O al G, Tutar E, Atalay S. Amiodarone-induced thyrotoxicosis in children and adolescents is a possible outcome in patients with low iodine intake. J Pediatr Endocrinol Metab 2010 23(4) 363-8. 

Bogazzi F, Bartalena L, Martino E. Approach to the patient with amiodarone-induced thyrotoxicosis. J Clin Endocrinol Metab 2010 95(6) 2529-35. 

In a retrospective study of the potential for major adverse cardiovascular events in 57 patients with amiodarone-induced thyrotoxicosis compared with 224 euthyroid patients for a mean of 49 months, the patients with thyrotoxicosis had a higher rate of events (32% versus 11%), mostly driven by a higher rate of ventricular tachydysrhythmias requiring admission (7.0% versus 1.3%) overall, there was a 2.7 times increased risk [26 ]. Thyrotoxicosis (HR = 2.68) and a left ventricular ejection fraction below 45% (HR = 2.52) were independent predictors of major adverse cardiovascular events. 

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