Total Thyroidectomy for Medically Refractory Amiodarone-Induced Thyrotoxicosis

Mehta, Ankit; Vallera, Raphaelle D.; Tate, Chad R.; Sager, Rebecca; Welch, Brian J.

doi:10.1080/08998280.2008.11928432

Cited by 7 publications

(11 citation statements)

References 18 publications

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“…Concerning nuclear changes after amiodarone administration, many follicular cells revealed pyknotic nuclei which indicate cell degeneration. This was in agreement with Mehta et al (2008) who noted pyknotic nuclei in the epithelium of many thyroid follicles of an amiodarone-induced thyrotoxicosis patient [30] . Iodine component of amiodarone is blamed to be the leading cause of this nuclear change through a p53-mechanism with subsequent oxidative stress [15] .…”

Section: Discussionsupporting

confidence: 92%

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Vitamin E Ameliorates the Toxic Effect of Amiodarone on Thyroid Gland in Rats: A Histological and Ultrastructural Study

Rasheed

Arsanyos

2018

Journal of Medical Histology

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Background: Amiodarone is a highly effective and class III antiarrhythmic drug. It can be used to treat wide range of arrhythmias. However, it is markedly concentrated in tissues leading to multiple adverse effects mainly on thyroid gland. The concomitant use of vitamin E with amiodarone in treatment of arrhythmias can ameliorate the hazardous effects of amiodarone on thyroid gland Aim of work: The aim of this work is to study the histological and ultrastructural effects of amiodarone as antiarrhythmic drug on the thyroid gland, as well as the ability of vitamin E to protect against amiodarone induced thyroid damage. Material and methods: Thirty adult male albino rats (weighing 150-200 g), were used in the study. Rats were divided into three groups (10 per group): Group A (Control group); Group B (Amiodarone treated group) and Group C (Amiodarone + Vitamin E treated group). Rats were sacrificed after 6 weeks of amiodarone administration. Thyroid gland was examined histologically and ultrastructurally. Results: Histological and ultrastructure examination of thyroid glands of rats treated with amiodarone showed disorganized follicles. Follicular epithelium showed focal disruption and desquamation. The interfollicular tissue showed increased collagen deposition. Electron microscopic examination revealed irregular nuclei, dilated rough endoplasmic reticulum and swollen mitochondria. Concomitant administration of vitamin E showed marked amelioration of hazardous effects of amiodarone with improved histologic and ultrastructural signs Conclusion: Amiodarone induces damage of the thyroid gland. Administration of vitamin E protects the thyroid gland and attenuates histopathological changes induced by amiodarone.

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Section: Discussionsupporting

confidence: 92%

“…The oral intake of amiodarone was chosen in this study because it is similar to the conventional clinical situation. This runs in line with Mehta et al (2008) who stated that this mode of administration approximates the human case [30] . The dose regimen of amiodarone used in the present study was 30 mg/kg/day for six weeks [25] .…”

Section: Discussionsupporting

confidence: 89%

Vitamin E Ameliorates the Toxic Effect of Amiodarone on Thyroid Gland in Rats: A Histological and Ultrastructural Study

Rasheed

Arsanyos

2018

Journal of Medical Histology

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“…Таким образом, кон-тролируемый режим лечения в этой группе пациентов был маловероятен. В целом были использованы приблизительно одинаковые дозировки препаратов, аналогичные тако-вым, описанным в других работах [8].…”

Section: лечение аитunclassified

“…АИТ II типа обычно лечат стероидами, так как данная форма представляет собой вос-палительное поражение щитовидной железы [7,8]. Рекомендуется назначение преднизо-на в дозе 40-60 мг/сут; такое лечение часто приводит к улучшению в течение 1-2 нед.…”

Section: Introductionunclassified

“…Прием глюкокортикоидов необходимо продолжать в течение 2-3 мес, а затем мед-ленно уменьшить их применение, чтобы из-бежать рецидива [7,8]. Назначение радио-йодтерапии нецелесообразно вследствие сниженного поглощения йода, отдаленного по времени эффекта такой терапии и потен-циальной опасности дальнейшего высво-бождения гормона [9].…”

Section: Introductionunclassified

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Efficacy of the surgical management of amiodarone-induced thyroiditis.

Dickfos

Franz

2017

Endo Serg

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Цель. Амиодарон, относящийся к антиаритмическим препаратам III класса, является жизненно важным лекарст-вом, однако он способен провоцировать развитие амиодарон-индуцированного тиреоидита (АИТ) -редкого, но сложного и угрожающего жизни побочного эффекта. АИТ может вызвать серьезную сердечную дисфункцию и привести к сердечной недостаточности. Заболевание обычно поддается медикаментозному лечению, но небольшая группа пациентов не отвечает на терапию, и у них функция сердечно-сосудистой системы продолжает ухудшаться. Больным из этой группы обычно выполняют тотальную тиреоидэктомию. Без хирургического удаления щитовидной железы состояние пациентов ухудшается; смертность среди непрооперированных пациентов достигает 30-50%. Целью данного исследования был поиск признаков, которые бы позволили более точно определить момент, когда пациента следует направлять на операцию, а также оценка эффективности этого метода лечения. Методы. Нами был проведен ретроспективный анализ серии случаев АИТ у пациентов, которым была выполнена тотальная тиреоидэктомия с целью лечения АИТ в период с 1998 по 2015 г., что было необходимо для оценки эффективности такой терапии, а также показаний для нее. Результаты. Мы наблюдали быстрое и значительное снижение уровня Т 4 после операции. Симптомы заболевания, как правило, исчезали после операции. Однако каких-либо четких показателей того, как долго следует проводить медикаментозную терапию, в рамках данной когорты больных нами выявлено не было. Заключение. Врачам следует рассматривать хирургическое вмешательство как действенный и эффективный способ лечения амиодарон-индуцированного тиреотоксикоза. Тем не менее остается неясным, когда следует направлять пациентов на это лечение. При лечении этих сложных пациентов следует применять индивидуальный подход. Ключевые слова: щитовидная железа, тиреоидит, тиреоидэктомия, эндокринная хирургия.Aim. Amiodarone, a class III anti-arrhythmic can be a life-saving medication however it can also cause amiodarone-induced thyroiditis (AmIT). Though rare, it is a complex and life-threatening side effect. AmIT can cause significant cardiac dysfunction and lead to cardiac failure. Though generally treated medically, a small sub-group do 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 30-50% mortality rate for those not operated on. The aim of this study was to assess for any indicators as to when these patients should be referred for total thyroidectomies and the efficacy of this method of treatment. Method. A case series of patients with amiodarone-induced thyroiditis treated with a total thyroidectomy from 1998-2015 was used to retrospectively assess the efficacy and indicators for surgery. Results. T 4 values decreased quickly and significantly after surgery. Patients' symptoms mostly resolved after surgery. No clear indicators were found to be common throughout the cohort a...

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Effect of Amiodarone on Thyroid Gland in Adult Male Albino Rats: A Histological and Immunohistochemical study

El-Sayed,

Hamdy²,

Moustafa³

et al. 2022

Egyptian Academic Journal of Biological Sciences, D. Histology

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Background: Amiodarone (AMD) is a benzofuran derivative, used in the management of angina and refractory ventricular arrhythmia. AMD may lead to either hypothyroidism or hyperthyroidism, depending on the daily dietary allowance of iodine. Aim of the Work: The aim of the current study is to investigate the structural and biochemical changes of the thyroid gland of adult male albino rats after exposure to different doses of AMD. Material and Methods: Thirty adult male albino rats were used in the experiment, they were divided into three groups; the Control group (Group I, N=10); AMD therapeutic dose-treated group (Group II, N=10), received AMD at a dose of 30 mg/Kg daily for 12 weeks by oral gavage; AMD toxic dose-treated group (Group III, N=10), received AMD at a dose of 60 mg/Kg daily for six weeks by oral gavage. At the end of the experiment, blood samples were taken from rats to estimate the serum concentration of tri-iodothyronine (T3), thyroxine (T4), and thyrotrophin (TSH). The thyroid glands of all rats were removed, and specimens from the glands were prepared and processed for histological examination under a light microscope. An immunohistochemical study was conducted using Caspase III. Results: Biochemical examination revealed a highly significant increase of serum T3 and T4, with Concomitant suppression of TSH. Histopathological examination of thyroid tissues from AMD therapeutic dose group (Group II) showed marked evidence of thyrotoxicosis in the form of microcystic follicular changes and peripheral scalloping, cellular degeneration with scanty cytoplasm and vesicular nuclei appeared. These changes became more severe in AMD toxic dose group (Group III) in the form of epithelial hyperplasia with atypical nuclear features, together with thyroid tissue damage with hemorrhage and necrosis. Conclusion: Amiodarone had detrimental effects on the rat's thyroid tissue when administered either in therapeutic or toxic doses.

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Total Thyroidectomy for Medically Refractory Amiodarone-Induced Thyrotoxicosis

Cited by 7 publications

References 18 publications

Vitamin E Ameliorates the Toxic Effect of Amiodarone on Thyroid Gland in Rats: A Histological and Ultrastructural Study

Vitamin E Ameliorates the Toxic Effect of Amiodarone on Thyroid Gland in Rats: A Histological and Ultrastructural Study

Efficacy of the surgical management of amiodarone-induced thyroiditis.

Effect of Amiodarone on Thyroid Gland in Adult Male Albino Rats: A Histological and Immunohistochemical study

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