Amiodarone-Induced Thyrotoxicosis Type 2: A Case Report and Review of the Literature

Benbassat, Carlos; Mechlis-Frish, Sara; Cohen, Maya; Blum, Ilana

doi:10.1097/00000441-200010000-00012

Cited by 7 publications

(4 citation statements)

References 9 publications

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“…Whether there is any other precipitating event is unclear. Iodine and amiodarone may also damage thyroid cells directly and release thyroid antigens to the immune system [55]. …”

Section: Drugsmentioning

confidence: 99%

Autoimmune Thyroid Disorders

2013

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Purpose of Review. Studies have been published in the field of autoimmune thyroid diseases since January 2005. The review is organized into areas of etiology, autoimmune features, autoantibodies, mechanism of thyroid cell injury, B-cell responses, and T-cell responses. Also it reviews the diagnosis and the relationship between autoimmune thyroid disease, neoplasm, and kidney disorders. Recent Findings. Autoimmune thyroid diseases have been reported in people living in different parts of the world including North America, Europe, Baalkans, Asia, Middle East, South America, and Africa though the reported figures do not fully reflect the number of people infected per year. Cases are unrecognized due to inaccurate diagnosis and hence are treated as other diseases. However, the most recent studies have shown that the human autoimmune thyroid diseases (AITDs) affect up to 5% of the general population and are seen mostly in women between 30 and 50 years. Summary. Autoimmune thyroid disease is the result of a complex interaction between genetic and environmental factors. Overall, this review has expanded our understanding of the mechanism involved in pathogenesis of AITD and the relationship between autoimmune thyroid disease, neoplasm, and kidney disease. It has opened new lines of investigations that will ultimately result in a better clinical practice.

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“…Whether there is any other precipitating event is unclear. Iodine and amiodarone may also damage thyroid cells directly and release thyroid antigens to the immune system [55]. …”

Section: Drugsmentioning

confidence: 99%

Autoimmune Thyroid Disorders

2013

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“…Während bei der Mehrheit der Patienten die beschriebenen Veränderungen der Schilddrüsenparameter als kompensatorisch zu bezeichnen sind, um eine Euthyreose des Patienten auch unter einem hypothyreoseinduzierenden Medikament aufrechtzuerhalten, kommt es bei einigen Patienten zu Abweichungen, die über dieses Maû hinaus gehen und denen auch andere Pathomechanismen zugrunde liegen und die damit eindeutig als krankhafte Schilddrüsen-funktionsstörungen einzuordnen sind [4,8,14,15,18,21].…”

Section: Amiodaron Und Schilddrüsenerkrankungenunclassified

“…Pathogenetisch, klinisch und auch therapeutisch ist es wichtig, eine Amiodaron-induzierte Hyperthyreose Typ 1 und Typ 2 zu unterscheiden [3,4,8,14,18,24]. Therapie der Amiodaron-induzierten Hyperthyreose Die Therapie der Amiodaron-induzierten Hyperthyreose richtet sich entscheidend nach ätiologischen Gesichtspunkten (Tab.…”

Section: Amiodaron-induzierte Hyperthyreoseunclassified

Amiodaron und Schilddrüsenfunktion

Hoermann¹

2004

Der Nuklearmediziner

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ZusammenfassungAmiodaron verändert in typischer Weise physiologische Parameter der Schilddrüsenfunktion bei fortbestehender Euthyreose und führt auch zu krankhaften Schilddrüsenfehlfunktionen (Hyperthyreose, Hypothyreose). Das verbesserte pathophysiologische Verständnis der Amiodaron-induzierten Hyperthyreose hat zur Unterscheidung von 2 unterschiedlichen Formen der Amiodaron-induzierten Hyperthyreose (Typ 1 und Typ 2) geführt. Die beiden Formen unterscheiden sich in charakteristischer Weise in klinischen Merkmalen und ihrer therapeutische Beeinflussbarkeit. Die Typ-1-Hyperthyreose, die iodinduziert auf dem Boden einer vorbestehenden Schilddrüsenerkrankung, meist einer Autonomie der Schilddrüse nach kurzem Gebrauch des Medikamentes entsteht, wird durch eine Kombination mit 2 antithyreoidalen Medikamenten, einem Syntheseblocker (Thiamazol) und einem Iodaufnahmeblocker (Perchlorat) behandelt. Die Typ-2-Hyperthyreose, der eine meist ohne vorausgehende Schilddrü-senerkrankung nach langem Medikamentengebrauch ausgelöste Thyreoiditis zugrunde liegt, wird in milden Formen rein symptomatisch und in schweren Formen mit Glukokortikoiden behandelt. Mischtypen kommen ebenfalls vor und werden kombiniert behandelt. Das Absetzen von Amiodaron ist differenziert zu betrachten und, wenn überhaupt, überlegt und kontrolliert durchzuführen. Gerade bei der Typ-2-Hyperthyreose kann das Medikament häufig ohne negativen Einfluss auf den weiteren Verlauf belassen werden. In Deutschland selten ist die Amiodaron-induzierte Hypothyreose, die mit Levothyroxin substituiert wird, mit einem höheren TSH-Zielwert als ansonsten üblich. AbstractAmiodarone affects normal thyroid function and may induce thyroid disorders (hyperthyroidism and hypothyroidism). Our understanding of the pathophysiology of amiodarone-associated thyroid diseases has improved since the introduction of the drug in 1970. We discern two types of hyperthyroidism termed type-Iand type-II-hyperthyroidism. Type-I-hyperthyroidism is caused by the iodine excess brought about by intake of the iodine rich drug in a patient with a pre-existing thyroid disorder, most frequently a toxic adenoma of the thyroid. The treatment of choice in type-I-hyperthyroidism is a combination of a thionamide drug (thiamazole) and an iodine uptake blocker (perchlorate). Type-IIhyperthyroidism is due to thyroiditis resulting in destruction of thyroid follicles and subsequent uncontrolled release of thyroid hormones. Therapy favours a wait and see approach in mild cases that have a good prognosis and tend to spontaneously remit and the use of steroids in more severe cases. Mixed types may occur and be treated with a combination of the measures described for each type. Withdrawal of amiodarone has to be planned carefully. In type-II-hyperthyroidism amiodarone may frequently be continued without adverse effect on the prognosis of the thyroid disease. Amiodarone-induced hypothyroidism is rare in Germany compared to other countries (USA). Levothyroxine replacement is recommended. Dose is individually adjusted ai...

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“…Patients developing type I thyrotoxicosis have a preexisting disorder of the thyroid gland (nodular goiter or latent Graves disease) whereas those developing type II thyrotoxicosis have a normal thyroid gland (Roti and Uberti, 2001). Type I amiodarone-induced thyrotoxicosis responds well to methimazole and potassium perchlorate (Bartalena et al, 1996), whereas type II amiodarone-induced thyrotoxicosis can effectively be managed by glucocorticoids (Bartalena et al, 1996;Benbassat et al, 2000). However, both may be resistant to conventional treatment.…”

Section: Thyrotoxicosis Due To Other Causesmentioning

confidence: 99%

Therapy of Hyperthyroidism

Miehle¹,

Paschke²

2003

Exp Clin Endocrinol Diabetes

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Hyperthyroidism is a common disorder and affects approximately 2 % of women and 0.2 % of men. The review focuses on the therapy of overt hyperthyroidism with special emphasis on treatment strategies in Germany and Europe. Current treatment schedules for the different causes of hyperthyroidism are described and new therapeutic aspects are discussed. Special sections deal with the treatment of hyperthyroidism in pregnancy, neonates and children, and the treatment of thyrotoxic storm.

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Amiodarone-Induced Thyrotoxicosis Type 2: A Case Report and Review of the Literature

Cited by 7 publications

References 9 publications

Autoimmune Thyroid Disorders

Autoimmune Thyroid Disorders

Amiodaron und Schilddrüsenfunktion

Therapy of Hyperthyroidism

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