How frequently should a patient taking amiodarone be screened for thyroid dysfunction?

Pazin‐Filho, Antônio; Jesus, Alexandre M. X. de; Magalhães, Patrícia Künzle Ribeiro; Melato, Luciano Henrique; Campos, Débora Ribeiro da Silva; Maciel, Benedito Carlos; Maciel, Léa M.Z.

doi:10.1590/s0100-879x2009000800009

Cited by 10 publications

(6 citation statements)

References 14 publications

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“…Based on the unified methods of thyroid function testing, and elimination of the effect of short-term use of amiodarone (Wolff-Chaikoff effect) and potential thyroid disease, the results of our meta-analysis using a random-effect model showed that the incidence rate of new-onset AIH was similar to that reported by Ross et al [13] and Pazin-Filho et al [14], but different from the incidence rate of AIH (1−32%) reported by Harjai and Licata [15]. This discrepancy may be due to the sample size, mean age of the patients, underlying diseases and screening for thyroid diseases before medication in these reports.…”

Section: Discussionsupporting

confidence: 82%

“…This discrepancy may be due to the sample size, mean age of the patients, underlying diseases and screening for thyroid diseases before medication in these reports. It was reported, for example, that Chagas' cardiomyopathy [14], diabetes mellitus [16] and congenital heart disease [17] are related to AIH; an imbalance in the sex ratio is likely to be one of the causes, as the proportion of women was the lowest (5-7%) in some studies, which may have led to the conclusion that male sex is related to AIH in some reports [11]. In our study, the proportion of women was 31%, and the mean age was 57 years.…”

Section: Discussionmentioning

confidence: 99%

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Environmental Iodine Content, Female Sex and Age Are Associated with New-Onset Amiodarone-Induced Hypothyroidism: A Systematic Review and Meta-Analysis of Adverse Reactions of Amiodarone on the Thyroid

et al. 2016

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Objectives: To investigate the incidence of new-onset amiodarone-induced hypothyroidism (AIH) and the associated risk factors. Methods: We performed a systematic search in MEDLINE, Embase, the Cochrane Library and the Chinese database from 1995 to 2015. Studies that investigated amiodarone-related adverse reactions on the thyroid were included. A random-effect model was used for the meta-analysis to investigate the incidence rate of AIH and associated risk factors. Results: We identified 465 studies, of which data from 9 studies were included, comprising 1,972 patients. The incidence of AIH was 14.0% (95% confidence interval, CI, 8.7-21.7%) as a whole; it was higher in areas with a high than a low iodine content in the environment (20.3 vs. 8.7%, p < 0.001); subgroup analysis showed that AIH occurred in 19.2% (95% CI 10.2-33.1%) of women and 13.3% (95% CI 7.9-21.7%) of men (p < 0.001). Meta-regression analysis indicated a positive correlation with the mean age and percentage of women. Conclusions: The occurrence of AIH is a relatively frequent complication of amiodarone, and older women are more likely to develop AIH, especially in areas with a high iodine content in the environment, and restriction of total exposure to iodine might decrease the incidence of AIH.

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Section: Discussionsupporting

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Environmental Iodine Content, Female Sex and Age Are Associated with New-Onset Amiodarone-Induced Hypothyroidism: A Systematic Review and Meta-Analysis of Adverse Reactions of Amiodarone on the Thyroid

et al. 2016

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“…A relationship between amiodarone dose and the development of thyroid dysfunction could not be measured due to the fact that almost all of the patients, whether euthyroid or had TD, were on a daily dose of 200 mg. This is in agreement with the previous reports that could not demonstrate an association between the duration of amiodarone treatment and TD which also used the small dose (200 mg/day) of amiodarone in the majority of patients [17, 27]. …”

Section: Discussionsupporting

confidence: 93%

“…As previously mentioned, AIT is more commonly observed in areas of low iodine intake [17, 27]. The reported incidence of AIT in iodine sufficient or replete areas is about 2% while in iodine depleted areas is it is 24% or even higher [17, 26].…”

Section: Discussionmentioning

confidence: 99%

Incidence and Pattern of Thyroid Dysfunction in Patients on Chronic Amiodarone Therapy: Experience at a Tertiary Care Centre in Oman

Farhan¹,

Albulushi²,

Taqi³

et al. 2013

TOCMJ

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Objective: To determine the incidence and pattern of thyroid dysfunction (TD) in patients on chronic amiodarone therapy. Methods: A retrospective study which evaluated 59 patients who had received amiodarone therapy regularly for at least 12 months from a period of 3 years from October 2007 to October 2010. The patients were followed-up at the cardiac clinic at Sultan Qaboos University Hospital, Muscat, Oman. Results: The mean age of the cohort was 63 ± 13 years ranging from 27 to 98 years. Fifty-one percent (n = 30) of the patients were female. There were 11 (19%) cases of thyroid dysfunction (TD). Seven (12%) patients were hypothyroid, 3 (5%) had hyperthyroidism and 1 (2%) patient had sub-clinical hypothyroidism; no cases of sub-clinical hyperthyroidism were noted. Female gender and presence of anti-thyroid peroxidase antibodies were significantly associated with amiodarone-induced hypothyroidism (p = 0.001) while age, amiodarone dose and duration of therapy were not correlated with the development of TD (all p-values > 0.05). Conclusion: Amiodarone-induced thyroid dysfunction is prevalent. Hypothyroidism was more frequent and seen more in female patients and those who had positive anti-thyroid peroxidase antibodies. Initial screening and periodic monitoring of thyroid function is mandatory for all patients on amiodarone therapy.

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“…There has been no clear consensus regarding the frequency of screening for amiodarone-induced thyroid dysfunction in patients on chronic amiodarone treatment. Given the time course of the onset of dysfunction and its unpredictability from baseline patient demographics, thyroid function tests (T4 and T3) should be checked every 6 months or sooner if clinically indicated [Pazin-Filho et al 2009]. Furthermore, before initiating therapy with amiodarone a complete thyroid examination should be performed along with baseline measurements of serum TSH, free T4, T3, and anti-thyroid peroxidase (TPO) antibodies.…”

Section: Monitoring Patients On Amiodaronementioning

confidence: 99%

Management of amiodarone-related thyroid problems

Narayana

Woods

Boos

2011

Therapeutic Advances in Endocrinology

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Amiodarone is a highly effective and well-established antiarrrhythmic drug. It can be used to treat supraventricular and ventricular tachyarrhythmias and has the added advantage of being well tolerated in patients with impaired left ventricular systolic function with a low incidence of arrhythmic events, such as torsades de pointes. However, owing to its marked lipid affinity, it is highly concentrated in tissues and is linked to a number of adverse effects, including thyroid dysfunction. Amiodarone can lead to both hypothyroidism (amiodaroneinduced hypothyroidism) and less commonly hyperthyroidism (amiodarone-induced thyrotoxicosis) and relates to high iodine content within the molecule as well as to several unique intrinsic properties of amiodarone. Dronedarone is a recently approved antiarrhythmic drug. It is structurally very similar to amiodarone, however the iodine moiety, present with amiodarone has been removed and replaced with a methylsulfonamide group to reduce fat solubility and adverse effects. We present an overview of the effects of amiodarone on thyroid function and the treatment options available, as well as a brief insight into dronedarone and its potential as an alternative to amiodarone.

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How frequently should a patient taking amiodarone be screened for thyroid dysfunction?

Cited by 10 publications

References 14 publications

Environmental Iodine Content, Female Sex and Age Are Associated with New-Onset Amiodarone-Induced Hypothyroidism: A Systematic Review and Meta-Analysis of Adverse Reactions of Amiodarone on the Thyroid

Environmental Iodine Content, Female Sex and Age Are Associated with New-Onset Amiodarone-Induced Hypothyroidism: A Systematic Review and Meta-Analysis of Adverse Reactions of Amiodarone on the Thyroid

Incidence and Pattern of Thyroid Dysfunction in Patients on Chronic Amiodarone Therapy: Experience at a Tertiary Care Centre in Oman

Management of amiodarone-related thyroid problems

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