Thyroid Dysfunction Induced by Amiodarone Therapy Follow-up

  • Author: Mini Gopalan, MD; Chief Editor: George T Griffing, MD   more...
 
Updated: Jan 3, 2012
 

Further Outpatient Care

Prolonged monitoring of thyroid function tests is necessary in patients with AIT, even if they become euthyroid, as they may become hypothyroid. Recurrences are common in type 2 AIT.

Next

Transfer

In cases of severe AIT or myxedema coma, consider a transfer to a specialized facility if an endocrinologist, intensivist, or cardiologist is not available to help with inpatient treatment.

Previous
Next

Deterrence/Prevention

Test baseline thyroid function in all patients starting amiodarone therapy to exclude underlying gland dysfunction that may predispose them to thyroid abnormalities after therapy begins. The serum levels of TSH, free T4, and free T3 may be reassessed after 3 months of amiodarone therapy. In patients with euthyroidism, thyroid function results may be used as reference for future comparisons. Periodically monitor serum TSH levels and other thyroid indices if TSH levels are abnormal or clinical suspicion of thyroid dysfunction exists. The threshold for performing thyroid function tests should be low in patients who are taking amiodarone or who have in the past, as type 2 AIT has an abrupt onset. Continue to measure thyroid function for at least a year after amiodarone therapy is discontinued.

Research indicates that another benzofuran-derived drug, dronedarone (Multaq), may be a useful alternative treatment for arrhythmia. Although apparently not as effective an antiarrhythmic as amiodarone, dronedarone seems to be less toxic to the thyroid.[8] Dronedarone was approved by the FDA on July 2, 2009.

Previous
Next

Complications

  • Hyperthyroidism, thyroid storm
  • Hypothyroidism, myxedema coma
  • Aplastic anemia secondary to perchlorate use
  • Agranulocytosis or hepatitis secondary to thionamides
Previous
Next

Prognosis

  • The prognosis for AIT may be very poor even though a wide range of antithyroid therapy is available. This prognosis emphasizes the need for careful monitoring of patients receiving amiodarone treatment.
  • The long-term prognosis for AIH is usually good.
Previous
Next

Patient Education

  • Instruct patients about the adverse effects of amiodarone therapy. Give them a list of potential symptom manifestations. Because the development of thyrotoxicosis is sudden and explosive, instruct patients to watch for symptoms and to seek treatment promptly.
  • Patients should also be aware of the potential side effects of antithyroid medications. Instruct patients to watch for signs such as fever, sore throat, jaundice, or oral ulcers.
Previous
 
Contributor Information and Disclosures
Author

Mini Gopalan, MD  Clinical Assistant Professor, Department of Medicine, Texas Tech University; Consulting Physician, Department of Internal Medicine, Midland Community Healthcare Services

Mini Gopalan, MD is a member of the following medical societies: American College of Physicians, American Medical Association, Endocrine Society, and Texas Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

James Burks, MD, FACP, FACE  Professor of Medicine, Program Director, Department of Medicine, Texas Tech University Health Sciences Center

James Burks, MD, FACP, FACE is a member of the following medical societies: American Association of Clinical Endocrinologists, American Diabetes Association, and Endocrine Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Robert A Gabbay, MD, PhD  Associate Professor of Medicine, Division of Endocrinology, Diabetes and Metabolism, Laurence M Demers Career Development Professor, Penn State College of Medicine; Director, Diabetes Program, Penn State Milton S Hershey Medical Center; Executive Director, Penn State Institute for Diabetes and Obesity

Robert A Gabbay, MD, PhD is a member of the following medical societies: American Association of Clinical Endocrinologists, American Diabetes Association, and Endocrine Society

Disclosure: Novo Nordisk Honoraria Speaking and teaching; Merck Honoraria Speaking and teaching

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Arthur B Chausmer, MD, PhD, FACP, FACE, FACN, CNS  Professor of Medicine (Endocrinology, Adj), Johns Hopkins School of Medicine; Affiliate Research Professor, Bioinformatics and Computational Biology Program, School of Computational Sciences, George Mason University; Principal, C/A Informatics, LLC

Arthur B Chausmer, MD, PhD, FACP, FACE, FACN, CNS is a member of the following medical societies: American Association of Clinical Endocrinologists, American College of Endocrinology, American College of Nutrition, American College of Physicians, American College of Physicians-American Society of Internal Medicine, American Medical Informatics Association, American Society for Bone and Mineral Research, Endocrine Society, and International Society for Clinical Densitometry

Disclosure: Nothing to disclose.

Frederick B Gaupp, MD  Consulting Staff, Department of Family Practice, Hancock Medical Center

Frederick B Gaupp, MD is a member of the following medical societies: American Academy of Family Physicians

Disclosure: Nothing to disclose.

Chief Editor

George T Griffing, MD  Professor of Medicine, St Louis University School of Medicine

George T Griffing, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Medical Practice Executives, American College of Physician Executives, American College of Physicians, American Diabetes Association, American Federation for Medical Research, American Heart Association, Central Society for Clinical Research, Endocrine Society, International Society for Clinical Densitometry, and Southern Society for Clinical Investigation

Disclosure: Nothing to disclose.

References

  1. Tsadok MA, Jackevicius CA, Rahme E, Essebag V, Eisenberg MJ, Humphries KH, et al. Amiodarone-induced thyroid dysfunction: brand-name versus generic formulations. CMAJ. Sep 6 2011;183(12):E817-23. [Medline]. [Full Text].

  2. Ahmed S, Van Gelder IC, Wiesfeld AC, Van Veldhuisen DJ, Links TP. Determinants and outcome of amiodarone-associated thyroid dysfunction. Clin Endocrinol (Oxf). Sep 2011;75(3):388-94. [Medline].

  3. Mosher MC. Amiodarone-induced hypothyroidism and other adverse effects. Dimens Crit Care Nurs. Mar-Apr 2011;30(2):87-93. [Medline].

  4. Hofmann A, Nawara C, Ofluoglu S, et al. Incidence and predictability of amiodarone-induced thyrotoxicosis and hypothyroidism. Wien Klin Wochenschr. 2008;120(15-16):493-8. [Medline].

  5. Piga M, Serra A, Boi F, et al. Amiodarone-induced thyrotoxicosis. A review. Minerva Endocrinol. Sep 2008;33(3):213-28. [Medline].

  6. Piga M, Cocco MC, Serra A, et al. The usefulness of 99mTc-sestaMIBI thyroid scan in the differential diagnosis and management of amiodarone-induced thyrotoxicosis. Eur J Endocrinol. Oct 2008;159(4):423-9. [Medline].

  7. Bogazzi F, Bartalena L, Tomisti L, et al. Potassium perchlorate only temporarily restores euthyroidism in patients with amiodarone-induced hypothyroidism who continue amiodarone therapy. J Endocrinol Invest. Jun 2008;31(6):515-9. [Medline].

  8. Han TS, Williams GR, Vanderpump MP. Benzofuran derivatives and the thyroid. Clin Endocrinol (Oxf). Jan 2009;70(1):2-13. [Medline].

  9. Amico JA, Richardson V, Alpert B, Klein I. Clinical and chemical assessment of thyroid function during therapy with amiodarone. Arch Intern Med. Mar 1984;144(3):487-90. [Medline].

  10. Bartalena L, Brogioni S, Grasso L, et al. Treatment of amiodarone-induced thyrotoxicosis, a difficult challenge: results of a prospective study. J Clin Endocrinol Metab. Aug 1996;81(8):2930-3. [Medline].

  11. Bartalena L, Grasso L, Brogioni S, et al. Serum interleukin-6 in amiodarone-induced thyrotoxicosis. J Clin Endocrinol Metab. Feb 1994;78(2):423-7. [Medline].

  12. Bogazzi F, Bartalena L, Brogioni S, et al. Color flow Doppler sonography rapidly differentiates type I and type II amiodarone-induced thyrotoxicosis. Thyroid. Aug 1997;7(4):541-5. [Medline].

  13. Bogazzi F, Bartalena L, Gasperi M, et al. The various effects of amiodarone on thyroid function. Thyroid. May 2001;11(5):511-9. [Medline].

  14. Claxton S, Sinha SN, Donovan S, et al. Refractory amiodarone-associated thyrotoxicosis: an indication for thyroidectomy. Aust N Z J Surg. Mar 2000;70(3):174-8. [Medline].

  15. Daniels GH. Amiodarone-induced thyrotoxicosis. J Clin Endocrinol Metab. Jan 2001;86(1):3-8. [Medline].

  16. Eaton SE, Euinton HA, Newman CM, et al. Clinical experience of amiodarone-induced thyrotoxicosis over a 3-year period: role of colour-flow Doppler sonography. Clin Endocrinol (Oxf). Jan 2002;56(1):33-8. [Medline].

  17. Figge J, Dluhy RG. Amiodarone-induced elevation of thyroid stimulating hormone in patients receiving levothyroxine for primary hypothyroidism. Ann Intern Med. Oct 1 1990;113(7):553-5. [Medline].

  18. Hamoir E, Meurisse M, Defechereux T, et al. Surgical management of amiodarone-associated thyrotoxicosis: too risky or too effective?. World J Surg. Jun 1998;22(6):537-42; discussion 542-3. [Medline].

  19. Harjai KJ, Licata AA. Effects of amiodarone on thyroid function. Ann Intern Med. Jan 1 1997;126(1):63-73. [Medline].

  20. Hermida JS, Jarry G, Tcheng E, Moullart V, Arlot S, Rey JL. Radioiodine ablation of the thyroid to allow the reintroduction of amiodarone treatment in patients with a prior history of amiodarone-induced thyrotoxicosis. Am J Med. Mar 1 2004;116(5):345-8. [Medline].

  21. Martino E, Aghini-Lombardi F, Mariotti S, et al. Amiodarone iodine-induced hypothyroidism: risk factors and follow-up in 28 cases. Clin Endocrinol (Oxf). Feb 1987;26(2):227-37. [Medline].

  22. Martino E, Aghini-Lombardi F, Mariotti S, et al. Treatment of amiodarone associated thyrotoxicosis by simultaneous administration of potassium perchlorate and methimazole. J Endocrinol Invest. Jun 1986;9(3):201-7. [Medline].

  23. Martino E, Bartalena L, Bogazzi F, Braverman LE. The effects of amiodarone on the thyroid. Endocr Rev. Apr 2001;22(2):240-54. [Medline].

  24. Martino E, Safran M, Aghini-Lombardi F, et al. Environmental iodine intake and thyroid dysfunction during chronic amiodarone therapy. Ann Intern Med. Jul 1984;101(1):28-34. [Medline].

  25. Newman CM, Price A, Davies DW, et al. Amiodarone and the thyroid: a practical guide to the management of thyroid dysfunction induced by amiodarone therapy. Heart. Feb 1998;79(2):121-7. [Medline].

  26. Osman F, Franklyn JA, Sheppard MC, Gammage MD. Successful treatment of amiodarone-induced thyrotoxicosis. Circulation. Mar 19 2002;105(11):1275-7. [Medline].

  27. Roti E, Minelli R, Gardini E, et al. Thyrotoxicosis followed by hypothyroidism in patients treated with amiodarone. A possible consequence of a destructive process in the thyroid. Arch Intern Med. Apr 12 1993;153(7):886-92. [Medline].

  28. Smyrk TC, Goellner JR, Brennan MD, Carney JA. Pathology of the thyroid in amiodarone-associated thyrotoxicosis. Am J Surg Pathol. Mar 1987;11(3):197-204. [Medline].

  29. Trip MD, Wiersinga W, Plomp TA. Incidence, predictability, and pathogenesis of amiodarone-induced thyrotoxicosis and hypothyroidism. Am J Med. Nov 1991;91(5):507-11. [Medline].

  30. Vorperian VR, Havighurst TC, Miller S, January CT. Adverse effects of low dose amiodarone: a meta-analysis. J Am Coll Cardiol. Sep 1997;30(3):791-8. [Medline].

  31. Williams M, Lo Gerfo P. Thyroidectomy using local anesthesia in critically ill patients with amiodarone-induced thyrotoxicosis: a review and description of the technique. Thyroid. Jun 2002;12(6):523-5. [Medline].

  32. Wolff J. Perchlorate and the thyroid gland. Pharmacol Rev. Mar 1998;50(1):89-105. [Medline].

 
Previous
Next
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.