Refractory Amiodarone‐associated Thyrotoxicosis: An Indication for Thyroidectomy

Claxton, Scott; Sinha, Sankar Narayan; Donovan, Shaun; Greenaway, TM; Hoffman, L; Loughhead, Michael G.; Burgess, John

doi:10.1046/j.1440-1622.2000.01780.x

Cited by 45 publications

(32 citation statements)

References 19 publications

(57 reference statements)

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“…Surgery has been advocated as effective management with one study reporting successful treatment of AIT with thyroidectomy, where the authors report surgery as lifesaving in the three most critical cases (13). Other groups have reported similar responses to surgery, especially when unresponsive to medical therapy (11,14). The present study was retrospective and prospective studies are required to confirm the findings.…”

Section: Discussionsupporting

confidence: 61%

“…Wong et al (7) reviewed 24 cases of AIT where five patients died, resulting in a 20.8% mortality. Since patients on amiodarone have underlying cardiac dysfunction (14) and often other co-morbidities, it is no surprise mortality is high when thyrotoxicosis, a pro-arrhythmic condition, develops (23). Moreover, the sensitivity of the cardiovascular system to develop arrthymias and cardiac failure in thyrotoxicosis is increased in the presence of pre-morbid cardiac dysfunction (23).…”

Section: Discussionmentioning

confidence: 99%

“…Amiodarone-induced thyrotoxicosis (AIT) remains a challenging problem with significant morbidity, due to worsening arrthymias (3) and even mortality (7). Medical management can be problematic, prompting the use of different medical treatments (5,6,8), plasmapheresis (9, 10) and surgery in some cases (11,12), especially when drug-unresponsive (13,14). However, the factors which are associated with mortality from AIT are less well defined.…”

Section: Introductionmentioning

confidence: 99%

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Amiodarone-induced thyrotoxicosis: left ventricular dysfunction is associated with increased mortality

O’Sullivan

Lewis²,

Diamond³

2006

eur j endocrinol

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Objective: Amiodarone-induced thyrotoxicosis (AIT) is a challenging management problem, since patients treated with amiodarone invariably have underlying heart disease. Consequently, thyrotoxicosis can significantly contribute to increased morbidity and mortality. The aim of this study was to compare the clinical outcome and hormone profiles of patients with AIT (n ¼ 60) with those with Graves' thyrotoxicosis (n ¼ 49) and toxic multinodular goitre (MNG, n ¼ 40). Design: A retrospective study of patients with AIT in a single institution was conducted. Methods: Data from patients with AIT over 12 years were collected. Results: Mean TSH levels were significantly suppressed in all three groups. However, there was no intergroup significant difference. Free thyroxine (T4) levels were significantly higher in AIT (45.6^3.5 pmol/l) and Graves' disease (44.6^4.0 pmol/l) compared with toxic MNG (31.5^5.1 pmol/l, P , 0.05). In contrast, free triiodothyronine (T3) levels were only significantly higher in Graves' disease (14.7^1.5 pmol/l, P ¼ 0.002) compared with AIT (8.6^0.7 pmol/l) and toxic MNG (7.4^0.5 pmol/l). Six deaths occurred in the patients with AIT (10.0%, P , 0.01) and no deaths occurred in the other groups. Amiodarone treatment (P ¼ 0.002) was the most significant predictor of death, whereas free T4, free T3 and age did not affect outcome. Within the amiodarone-treated group severe left ventricular dysfunction (P ¼ 0.0001) was significantly associated with death. Conclusions: (i) AIT differs from other forms of thyrotoxicosis, and (ii) severe left ventricular dysfunction is associated with increased mortality in AIT.European Journal of Endocrinology 154 533-536

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Section: Discussionsupporting

confidence: 61%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Amiodarone-induced thyrotoxicosis: left ventricular dysfunction is associated with increased mortality

O’Sullivan

Lewis²,

Diamond³

2006

eur j endocrinol

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“…Yet, amiodarone also decreases peripheral deiodination of thyroxine (T 4 ) to triiodothyronine (T 3 ) by inhibiting liver type I iodothyronine 5′-deiodination of T 4 . 3 This interference in thyroid function can lead to AIT, a complex and life-threatening side effect with an incidence of 3 to 5% in Australia. 4 It is difficult to manage due unresponsiveness to medication, worsening of tachyarrhythmias in patients with poor cardiac function, and the possibility of needing to continue amiodarone to control an arrhythmia.…”

Section: Introductionmentioning

confidence: 99%

“…6 The onset is rapid and fulminant. The TFTs usually show a low thyroid-stimulating hormone (TSH), a high T 4 , and normal or slightly high T 3 . There is little evidence of an autoimmune mechanism, as serum antithyroglobulin, antimicrosomal, and antithyrotropin receptor antibodies are usually undetectable.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of the Surgical Management of Amiodarone-induced Thyrotoxicosis

Dickfos¹,

Franz²

2017

World Journal of Endocrine Surgery

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Introduction: Amiodarone can be a life-saving medication; however, it can also cause amiodarone-induced thyrotoxicosis (AIT). Though rare, AIT is a complex and life-threatening side effect, which can cause significant cardiac dysfunction and lead to cardiac failure. Primary treatment is with thionamides, perchlorates, and steroids. However, a small subgroup does not respond and their cardiovascular function continues to deteriorate. This select group is referred for a semi-elective total thyroidectomy. Without surgical removal of their thyroid gland, these patients will continue to deteriorate, with a 30 to 50% mortality rate for those not operated on.

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Current Awareness

2000

Pharmacoepidem. Drug Safe.

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In order to keep subscribers up‐to‐date with the latest developments in their field, John Wiley & Sons are providing a current awareness service in each issue of the journal. The bibliography contains newly published material in the field of pharmacoepidemiology and drug safety. Each bibliography is divided into 19 sections: 1 Books, Reviews & Symposia; 2 General; 3 Anti‐infective Agents; 4 Cardiovascular System Agents; 5 CNS Depressive Agents; 6 Non‐steroidal Anti‐inflammatory Agents; 7 CNS Agents; 8 Anti‐neoplastic Agents; 9 Haematological Agents; 10 Neuroregulator‐Blocking Agents; 11 Dermatological Agents; 12 Immunosuppressive Agents; 13 Autonomic Agents; 14 Respiratory System Agents; 15 Neuromuscular Agents; 16 Reproductive System Agents; 17 Gastrointestinal System Agents; 18 Anti‐inflammatory Agents ‐ Steroidal; 19 Others. Within each section, articles are listed in alphabetical order with respect to author. If, in the preceding period, no publications are located relevant to any one of these headings, that section will be omitted.

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Refractory Amiodarone‐associated Thyrotoxicosis: An Indication for Thyroidectomy

Abstract: Amiodarone-associated thyrotoxicosis may be severe and refractory to medical therapy. Despite the potential risks of anaesthesia associated with uncontrolled thyrotoxicosis, thyroidectomy should be considered in the setting of life-threatening thyrotoxicosis.

Cited by 45 publications

References 19 publications

Amiodarone-induced thyrotoxicosis: left ventricular dysfunction is associated with increased mortality

Amiodarone-induced thyrotoxicosis: left ventricular dysfunction is associated with increased mortality

Efficacy of the Surgical Management of Amiodarone-induced Thyrotoxicosis

Current Awareness

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