Refractory Amiodarone-induced Thyrotoxicosis: The Surgical Option

Abstract

Amiodarone-induced thyrotoxicosis is often poorly tolerated owing to underlying cardiac disease, and frequently resistant to medical therapy. We describe a 48-year-old patient with severe cardiac disease who developed amiodarone-associated thyrotoxicosis, refractory to standard medical therapy. Due to the unremitting thyrotoxicosis, a total thyroidectomy was performed without complications resulting in rapid correction of the thyrotoxicosis and enabling resumption of amiodarone therapy. Despite the concerns inherent to severe cardiac disease, total thyroidectomy can be performed safely in patients with resistant amiodarone-induced thyrotoxicosis. We believe that surgery should be considered early in the treatment planning. How to cite this article Ishay A, Carmeli J, Rozner E, Luboshitzky R. Refractory Amiodarone-induced Thyrotoxicosis: The Surgical Option. World J Endoc Surg 2013;5(1):21-24.

Surgery in Refractory Amiodarone-Induced Thyrotoxicosis

“…It is classified as iodine-induced thyrotoxicosis (type 1) existing in patients with underlying thyroid disease exacerbated by thyroid autonomous function, mainly in iodine-deficient areas and destructive thyroiditis (type 2) in those with no history of thyroid problems causing direct cytotoxic and inflammatory effects, occurring in iodine-repleted areas. [4] Mixed forms also are present. Those effects are probably due to high iodine content of amiodarone, and its long half-life (107 days).…”

“…[2] Mixed cases of amiodarone induced thyrotoxicosis occur in 15 to 27% of cases. [4] In patients with preexisting cardiac disease, the effect on heart is more worrisome. When established, AIT worsens the underlying arrhythmia and most patients developed decompensated heart failure, recurrent atrial fibrillation or any arrhytmia because of the superimposed hyperthyroid state.…”