Diagnosis and management of amiodarone‐induced thyrotoxicosis in Europe: results of an international survey among members of the European Thyroid Association

Abstract

Areas of certainty and uncertainty concerning AIT are present among expert European thyroidologists, both from a diagnostic and a therapeutic standpoint. Diagnostic criteria need to be refined in order to improve therapeutic outcome.

Radioiodine therapy in patients with type II amiodarone‑induced thyrotoxicosis

“…9 The pathogenesis of AM-induced thyrotoxicosis (AIT), which often has a sudden onset, is not well understood. [10][11][12] Based on its physiology, AIT is divided into 2 types. Type I AIT is an aggravation of the present thyroid disease by high iodine content; type II AIT is a result of thyroid damage in patients with normal thyroid function.…”

Benzofuran derivatives and the thyroid

“…Surveys of members of the European Thyroid Association 68 and the Latin American Thyroid Society 68 on the management of AIT have indicated substantial disparity in diagnostic investigations and therapy. Both surveys demonstrate the difficulty in differentiating type I from type II AIT and wide differences in the approach to management amongst thyroid specialists.…”

Efficacy of the Surgical Management of Amiodarone-induced Thyrotoxicosis

“…Conservative management may not be suitable due to the possible worsening of preexisting arrhythmias, cardiac failure, angina pectoris, and cardiomyopathy. 1,7 When feasible, current practice is to withdraw amiodarone to stop the prolongation of thyrotoxicosis; however, this may not alter the immediate clinical situation. Additionally, due to the inhibition of peripheral deiodination, there can be a paradoxical worsening of the patient's condition on cessation of therapy.…”

“…8 The medical management is challenging, poorly understood, and lacks a proven, consistent therapeutic armamentarium. 1,9 In Australia, type I is typically managed by the simultaneous administration of thionamides and potassium perchlorate. Type II is commonly treated by steroids and improvement is often seen within 2 weeks.…”

“…It has been shown to improve survival rates in patients with heart failure and effective in treating cardiac arrhythmias, which are refractory to other medications. 1,2 Amiodarone is generally administered in doses 50 to 100 times the daily iodine requirement. This iodine load can trigger increased thyroid hormone synthesis and release.…”