Management of amiodarone‐induced thyrotoxicosis in Latin America: an electronic survey

Diehl, Leandro Arthur; Romaldini, João Hamilton; Graf, Hans; Bartalena, Luigi; Martino, Enio; Albino, Cláudio Cordeiro; Wiersinga, Wilmar M.

doi:10.1111/j.1365-2265.2006.02590.x

Cited by 32 publications

(19 citation statements)

References 33 publications

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“…113,115 The management of patients with amiodarone-induced hyperthyroidism can be difficult, and no uniform consensus exists among thyroidologists on the proper form of treatment. 116 It is important to measure serum TSH, total and free T 4 , and total T 3 as well as antithyroid antibodies. ␤-Adrenergic blockade, if not already in place, is appropriate.…”

Section: Amiodarone and Thyroid Functionmentioning

confidence: 99%

Thyroid Disease and the Heart

Klein¹,

Danzi²

2016

Current Problems in Cardiology

136

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Abstract-The cardiovascular signs and symptoms of thyroid disease are some of the most profound and clinically relevant findings that accompany both hyperthyroidism and hypothyroidism. On the basis of the understanding of the cellular mechanisms of thyroid hormone action on the heart and cardiovascular system, it is possible to explain the changes in cardiac output, cardiac contractility, blood pressure, vascular resistance, and rhythm disturbances that result from thyroid dysfunction. The importance of the recognition of the effects of thyroid disease on the heart also derives from the observation that restoration of normal thyroid function most often reverses the abnormal cardiovascular hemodynamics. In the present review, we discuss the appropriate thyroid function tests to establish a suspected diagnosis as well as the treatment modalities necessary to restore patients to a euthyroid state. We also review the alterations in thyroid hormone metabolism that accompany chronic congestive heart failure and the approach to the management of patients with amiodarone-induced alterations in thyroid function tests.

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Section: Amiodarone and Thyroid Functionmentioning

confidence: 99%

Thyroid Disease and the Heart

Klein¹,

Danzi²

2016

Current Problems in Cardiology

136

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“…Terapia RAI nie jest zazwyczaj możliwa u pacjentów z AIT z powodu niskiego wychwytu jodu (RAIU) [2,74]. Niektóre badania pokazują jednak, że stosowanie RAI w tych przypadkach może czasami być uzasadnione, zwłaszcza u pacjentów z AIT o przewadze typu 1 [75].…”

Section: Typ 1 Aitunclassified

“…RAI therapy is usually not feasible in AIT patients because of low RAIU [2,74]. An open study suggested, however, that RAI may have some value also in these cases, especially in patients with a predominately type 1 AIT [75].…”

Section: Rai Therapymentioning

confidence: 99%

Amiodaron i tarczyca

Jabrocka‐Hybel

Bednarczuk

Bartalena

et al. 2015

Endokrynologia Polska

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Amiodarone, a benzofuranic iodine-rich antiarrhythmic drug, causes thyroid dysfunction in 15-20% of cases. Amiodarone can cause both hypothyroidism (AIH, amiodarone-induced hypothyroidism) and thyrotoxicosis (AIT, amiodarone-induced thyrotoxicosis). AIH is treated by L-thyroxin replacement and does not need amiodarone discontinuation. There are two main forms of AIT: type 1, a form of true iodineinduced hyperthyroidism; and type 2, a drug-induced destructive thyroiditis. However, mixed/indefinite forms exist, contributed to by both pathogenic mechanisms. Type 1 AIT usually occurs in diseased thyroid glands, whereas type 2 AIT develops in substantially normal thyroid glands. Thioamides represent the first-line treatment for type 1 AIT, but iodine-replete glands are poorly responsive; sodium/ /potassium perchlorate, by inhibiting thyroidal iodine uptake, may increase the response to thioamides. Type 2 AIT is best treated by oral glucocorticoids. Response depends on thyroid volume and severity of thyrotoxicosis. Mixed/indefinite forms may require a combination of thioamides, potassium perchlorate, and steroids. Radioiodine treatment is usually not feasible because amiodarone-related iodine load decreases thyroidal radioiodine uptake. Thyroidectomy represents an important and helpful option in cases resistant to medical therapy. Surgery performed by a skilled surgeon may represent an emergent treatment in patients who have severe cardiac dysfunction. StreszczenieLek antyarytmiczny -amiodaron, pochodna benzofuranu bogata w jod, wywołuje zaburzenia funkcji tarczycy w 15-20% przypadków. Amiodaron może powodować niedoczynność tarczycy (AIH) oraz nadczynność tarczycy (AIT). AIH jest leczona substytucyjnie lewotyroksyną, w jej przypadku nie jest konieczne odstawienie amiodaronu. Nadczynność tarczycy indukowaną amiodaronem dzielimy na dwa typy: typ 1 -nadczynność tarczycy związana z nadmierną produkcją hormonów tarczycowych, oraz typ 2, w której dominuje proces zapalenia tarczycy związanego z rozpadem gruczołu. Wyróżnia się również typ mieszany/nieokreślony, w którego patomechanizmie udział biorą oba powyżej opisane mechanizmy. Typ 1 AIT występuje zwykle na podłożu wcześniej występującej choroby tarczycy, zaś typ 2 w pierwotnie zdrowym gruczole tarczowym. Tionamidy są lekiem pierwszego rzutu w leczeniu typu 1 AIT, nadchloran sodowy/ /potasowy poprzez hamowanie wychwytu jodu może zwiększać odpowiedź na tionamidy. AIT typu 2 jest leczone głównie z zastosowaniem glikokortykosteroidów. Odpowiedź na leczenie zależy od wielkości gruczołu tarczowego i ciężkości tyreotoksykozy. Postaci mieszane mogą wymagać zastosowania złożonej terapii z użyciem tionamidów, nadchloranu sodowego/potasowego oraz steroidów. Leczenie radiojodem często jest niemożliwe z powodu zmniejszonego wychwytu jodu u pacjentów wcześniej leczonych amiodaronem. Zabieg usunięcia tarczycy jest bardzo pomocną formą leczenia nadczynności tarczycy indukowanej jodem, szczególnie w przypadkach opornych na leczenie farmakologiczne. Tyroidektomia wykonana przez do...

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“…g) Varia: Amiodaron and interferon induced thyroid disease Amiodarone is a potent iodine-rich drug; however, side effects on the thyroid and other organs may counterbalance its beneficial effects on the heart. It can cause isolated abnormalities of thyroid function tests and overt thyroid dysfunction, either hypothyroidism (amiodarone-induced hypothyroidism [AIH]) or thyrotoxicosis (amiodarone-induced thyrotoxicosis [AIT] [84]). It may develop early on or after many years of amiodarone treatment, sometimes following drug withdrawal due to prolonged tissue storage of iodinated amiodarone metabolites [85].…”

Section: Tips and Tricksmentioning

confidence: 99%

Thyroid Ultrasound: State of the Art Part 1 – Thyroid Ultrasound reporting and Diffuse Thyroid Diseases

et al. 2017

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Accurate differentiation of focal thyroid nodules (FTL) and thyroid abnormalities is pivotal for proper diagnostic and therapeutic work-up. In these two part articles, the role of ultrasound techniques in the characterization of FTL and evaluation of diffuse thyroid diseases is described to expand on the recently published World Federation in Ultrasound and Medicine (WFUMB) thyroid elastography guidelines and review how this guideline fits into a complete thyroid ultrasound exam.

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Management of amiodarone‐induced thyrotoxicosis in Latin America: an electronic survey

Abstract: There are several points of disagreement among thyroidologists regarding AIT management, mainly in the radiological evaluation and the approach to the already stabilized patient if amiodarone needs to be restarted.

Cited by 32 publications

References 33 publications

Thyroid Disease and the Heart

Thyroid Disease and the Heart

Amiodaron i tarczyca

Thyroid Ultrasound: State of the Art Part 1 – Thyroid Ultrasound reporting and Diffuse Thyroid Diseases

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