Abstract
Background A 75-year-old man had a myocardial infarction complicated by poor left ventricular function and non-sustained ventricular tachycardia. He began treatment with amiodarone and 12 months later developed symptoms of thyrotoxicosis.
Investigations Thyroid function tests after commencement of amiodarone revealed a high-normal level of free T4 and low-normal level of free T3 with a normal serum TSH. When symptoms of thyrotoxicosis developed, significant rises in T4 and T3 levels and suppression of TSH were observed. Thyroid autoantibodies were detected and thyroid ultrasonography revealed a small multinodular goiter.
Diagnosis Amiodarone-induced thyrotoxicosis (AIT) with features consistent with both AIT type I (in which thyroid antibodies and nodular goiter are present) and AIT type II (which is not responsive to thionamide therapy and eventually leads to permanent hypothyroidism).
Management The patient continued to be treated with amiodarone. He commenced thionamide (carbimazole) therapy but failed to improve, even after a dose increase. Glucocorticoid (prednisolone) therapy was therefore added. Combination therapy was associated with gradual clinical and biochemical improvement. The patient became persistently hypothyroid after stopping thionamide and glucocorticoid therapy and was stabilized on long-term thyroxine replacement.
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References
Newman CM et al. (1998) Amiodarone and the thyroid: a practical guide to the management of thyroid dysfunction induced by amiodarone therapy. Heart 79: 121–127
Martino E et al. (2001) The effects of amiodarone on the thyroid. Endocr Rev 22: 240–254
Davies PH et al. (1992) Treatment of amiodarone induced thyrotoxicosis with carbimazole alone and continuation of amiodarone. BMJ 305: 224–225
Smyrk TC et al. (1987) Pathology of the thyroid in amiodarone-associated thyrotoxicosis. Am J Surg Pathol 11: 197–204
Osman F et al. (2002) Successful treatment of amiodarone-induced thyrotoxicosis. Circulation 105: 1275–1277
Eaton SE et al. (2002) Clinical experience of amiodarone-induced thyrotoxicosis over a 3-year period: role of colour-flow Doppler sonography. Clin Endocrinol (Oxf) 56: 33–38
Basaria S and Cooper DS (2005) Amiodarone and the thyroid. Am J Med 118: 706–714
Daniels GH (2001) Amiodarone-induced thyrotoxicosis. J Clin Endocrinol Metab 86: 3–8
Martino E et al. (1988) Radioactive iodine thyroid uptake in patients with amiodarone-iodine-induced thyroid dysfunction. Acta Endocrinol (Copenh) 119: 167–173
Bogazzi F et al. (1997) Color flow Doppler sonography rapidly differentiates type I and type II amiodarone-induced thyrotoxicosis. Thyroid 7: 541–545
Bartalena L et al. (2004) Diagnosis and management of amiodarone-induced thyrotoxicosis in Europe: results of an international survey among members of the European Thyroid Association. Clin Endocrinol (Oxf) 61: 494–502
Osman F et al. (2007) Cardiovascular manifestations of hyperthyroidism before and after antithyroid therapy: a matched case–control study. J Am Coll Cardiol 49: 71–81
Hermida JS et al. (2004) Radioiodine ablation of the thyroid to allow the reintroduction of amiodarone treatment in patients with a prior history of amiodarone-induced thyrotoxicosis. Am J Med 116: 345–348
Bogazzi F et al. (2007) Glucocorticoid response to amiodarone-induced thyrotoxicosis due to destructive thyroiditis is predicted by thyroid volume and serum free thyroid hormone concentrations. J Clin Endocrinol Metab 92: 556–562
Bogazzi F et al. (2003) Treatment of type II amiodarone-induced thyrotoxicosis by either iopanoic acid or glucocorticoids: a prospective, randomized study. J Clin Endocrinol Metab 88: 1999–2002
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Franklyn, J., Gammage, M. Treatment of amiodarone-associated thyrotoxicosis. Nat Rev Endocrinol 3, 662–666 (2007). https://doi.org/10.1038/ncpendmet0592
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DOI: https://doi.org/10.1038/ncpendmet0592
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