PDF herunterladen
Exp Clin Endocrinol Diabetes 2005; 113(3): 145-151
DOI: 10.1055/s-2005-837524
Article

J. A. Barth Verlag in Georg Thieme Verlag KG Stuttgart · New York

Amiodarone-Induced Thyrotoxicosis Due to Destructive Thyroiditis

Therapeutic RecommendationsM. Dietlein1 , H. Schicha1
  • 1Department of Nuclear Medicine, University of Cologne, Cologne, Germany
Weitere Informationen

Publikationsverlauf

Received: March 13, 2004 First decision: June 21, 2004

Accepted: September 9, 2004

Publikationsdatum:
23. März 2005 (online)

Auch verfügbar auf
    Lizenzen und Reprints

Abstract

Background: Amiodarone-induced thyrotoxicosis (AIT) type 1 occurs in subjects with an underlying thyroid disease, whereas type 2 AIT is a form of destructive thyroiditis. Our hypothesis was that the common practice of thyroid testing before prescription of amiodarone would reduce the incidence of pure type 1 AIT, though a stringent classification may be difficult (mixed type AIT).

Materials and Methods: Thyroid testing before and after treatment of AIT (n = 12) and the response to combined antithyroid and glucocorticoid treatment (n = 11) were recorded in a consecutive series of patients seen at a university hospital.

Results: Some criteria for type 1 AIT were fulfilled in 3 patients, but the diagnosis of a mixed form AIT was more likely in 2 of these. Type 2 AIT was diagnosed in the other 9 patients, while 6 patients had diffuse hypoechoic goitre. The median time to euthyroidism (defined as normal fT3 concentration) under thionamide and prednisolone (starting dose 20 to 75 mg/d) was 2 months (interquartile range 1 to 2.7 months). Thionamide treatment was stopped after a median duration of 5.7 months (interquartile range 4.2 to 8.7 months) and glucocorticoids were completely withdrawn after 6.7 months (5.5 to 8.7 months).

Conclusions: Nowadays, isolated type 1 AIT is rarely found and destructive thyroiditis (as type 2 AIT or mixed form) is the predominant cause of AIT. To accelerate recovery, we prescribed thionamide and glucocorticoids simultaneously as first-line therapy once contraindications for the use of steroids had been ruled out.

Key words

Amiodarone - thyrotoxicosis - thyroiditis - glucocorticoids - thionamide

References

  • 1 Bartalena L, Bogazzi F, Martino E. Amiodarone-induced thyrotoxicosis: a difficult diagnostic and therapeutic challenge.  Clin Endocrinol. 2002;  56 23-24
    CrossrefPubMedSuche in Google Scholar
  • 2 Bartalena L, Brogioni S, Grasso L, Bogazzi F, Burelli A, Martino E. Treatment of amiodarone-induced thyrotoxicosis, a difficult challenge: results of a prospective study.  J Clin Endocrinol Metab. 1996;  81 2930-2933
    CrossrefPubMedSuche in Google Scholar
  • 3 Bartalena L, Brogioni S, Grasso L, Velluzzi F, Martino E. Relationship of the increased serum interleukin-6 concentration to changes of thyroid function in nonthyroidal illness.  J Endocrinol Invest. 1993;  17 269-273
    PubMedSuche in Google Scholar
  • 4 Bartalena L, Grasso L, Brogioni S, Aghini-Lombardi F, Braverman L E, Martino E. Serum interleukin-6 in amiodarone-induced thyrotoxicosis.  J Clin Endocrinol Metab. 1994;  78 423-427
    CrossrefPubMedSuche in Google Scholar
  • 5 Bogazzi F, Bartalena L, Brogioni S, Mazzeo S, Vitti P, Burelli A, Bartolozzi C, Martino E. Color flow doppler sonography rapidly differentiates type I and type II amiodarone-induced thyrotoxicosis.  Thyroid. 1997;  7 541-545
    CrossrefPubMedSuche in Google Scholar
  • 6 Bogazzi F, Bartalena L, Cosci C, Brogioni S, Dell'Unto E, Grasso L, Aghini-Lombardi F, Rossi G, Pinchera A, Braverman L E, Martino E. Treatment of type II amiodarone-induced thyrotoxicosis by either iopanoic acid or glucocorticoids. A prospective, randomised study.  J Clin Endocrinol Metab. 2003 a;  88 1999-2002
    CrossrefPubMedSuche in Google Scholar
  • 7 Bogazzi F, Martino E, Dell'Unto E, Brogioni S, Cosci C, Aghini-Lombardi F, Ceccarelli C, Pinchera A, Bartalena L, Braverman L E. Thyroid color flow doppler sonography and radioiodine uptake in 55 consecutive patients with amiodarone-induced thyrotoxicosis.  J Endocrinol Invest. 2003 b;  26 635-640
    PubMedSuche in Google Scholar
  • 8 Bonnyns M, Sterling I, Renard M. Dexamethasone treatment of amiodarone-induced thyrotoxicosis (AIT) with or without persistent administration of the drug.  Acta Cardiol. 1989;  44 235-243
    PubMedSuche in Google Scholar
  • 9 Brennan M D, van Heerden J A, Carney J A. Amiodarone-associated thyrotoxicosis (AAT): experience with surgical management.  Surgery. 1987;  102 1062-1067
    PubMedSuche in Google Scholar
  • 10 Broussolle C, Ducottet X, Martin C, Barbier Y, Bornet H, Noel G, Orgiazzi J. Rapid effectiveness of prednisone and thionamide combined therapy in severe amiodarone iodine-induced thyrotoxicosis. Comparison of two groups of patients with apparently normal thyroid glands.  J Endocrinol Invest. 1989;  12 37-42
    PubMedSuche in Google Scholar
  • 11 Burch H B. Abnormal thyroid function test results in euthyroid persons. Becker KL Principles and Practice of Endocrinology and Metabolism. 2nd ed. Philadelphia; Lippincott Company 1995: 323-332
    Suche in Google Scholar
  • 12 Cardenas G A, Cabral J M, Leslie C A. Amiodarone induced thyrotoxicosis: diagnostic and therapeutic strategies.  Cleve Clin J Med. 2003;  70 624-626 628-631
    PubMedSuche in Google Scholar
  • 13 Eaton S EM, Euinton H A, Newman C M, Weetman A P, Bennet W M. Clinical experience of amiodarone-induced thyrotoxicosis over a 3-year period: role of colour-flow Doppler sonography.  Clin Endocrinol. 2002;  56 33-38
    CrossrefPubMedSuche in Google Scholar
  • 14 Erdogan M F, Gülec S, Tutar E, Baskal N, Erdogan G. A stepwise approach to the treatment of amiodarone-induced thyrotoxicosis.  Thyroid. 2003;  13 205-209
    CrossrefPubMedSuche in Google Scholar
  • 15 Leger A F, Massin J P, Laurent M F, Vincens M, Auriol M, Helal O B, Chomette G, Savoie J C. Iodine-induced thyrotoxicosis: analysis of eighty-five consecutive cases.  Eur J Clin Invest. 1984;  14 449-457
    PubMedSuche in Google Scholar
  • 16 Leung P M, Quinn N D, Belchetz P E. Amiodarone-induced thyrotoxicosis: not a benign condition.  IJCP. 2002;  56 44-46
    PubMedSuche in Google Scholar
  • 17 Lombardi A, Martino E, Braverman L E. Amiodarone and the thyroid.  Thyroid Today. 1990;  13 1-7
    PubMedSuche in Google Scholar
  • 18 Martino E, Aghini-Lombardi F, Bartalena L, Grasso L, Loviselle A, Velluzzi F, Pinchera A, Braverman L E. Enhanced susceptibility to amiodarone-induced hypothyroidism in patients with thyroid autoimmune disease.  Arch Intern Med. 1994;  154 2722-2726
    PubMedSuche in Google Scholar
  • 19 Martino E, Aghini-Lombardi F, Mariotti S, Lenziardi M, Baschieri L, Braverman L E, Pinchera A. Treatment of amiodarone associated thyrotoxicosis by simultaneous administration of potassium perchlorate and methimazole.  J Endocrinol Invest. 1986;  9 201-207
    PubMedSuche in Google Scholar
  • 20 Martino E, Bartalena L, Bogazzi F, Braverman L E. The effects of amiodarone on the thyroid.  Endocrine Reviews. 2001;  22 240-254
    CrossrefPubMedSuche in Google Scholar
  • 21 Meier C A, Burger A G. Effects of pharmacologic agents on thyroid hormone homeostasis. Braverman LE, Utiger RD Werner and Ingbar's the Thyroid: A Fundamental and Clinical Text. 7th ed. Philadelphia, New York; Lippincott-Raven Publishers 1996: 276-286
    Suche in Google Scholar
  • 22 Miehle K, Paschke R. Therapy of hyperthyroidism.  Exp Clin Endocrinol Diabetes. 2003;  111 305-318
    Thieme ConnectPubMedSuche in Google Scholar
  • 23 Newmann C M, Price A, Davies D W, Gray T A, Weetman A P. Amiodarone and the thyroid: a practical guide to the management of thyroid dysfunction induced by amiodarone therapy.  Heart. 1998;  79 121-127
    PubMedSuche in Google Scholar
  • 24 Newnham H H, Topliss D J, Le Grand B A, Chosich N, Harper R W, Stockigt J R. Amiodarone-induced hyperthyroidism: assessment of the predictive value of biochemical testing and response to combined therapy using propylthiouracil and potassium perchlorate.  Aust NZ J Med. 1988;  18 37-44
    PubMedSuche in Google Scholar
  • 25 Osman F, Franklyn J A, Sheppard M C, Gammage M D. Successful treatment of amiodarone-induced thyrotoxicosis.  Circulation. 2002;  105 1275-1277
    PubMedSuche in Google Scholar
  • 26 Saleh A, Cohnen M, Fürst G, Godehardt E, Mödder U, Feldkamp J. Differential diagnosis of hyperthyroidism: Doppler sonographic quantification of thyroid blood flow distinguishes between Graves' disease and diffuse toxic goiter.  Exp Clin Endocrinol Diabetes. 2002;  110 32-36
    Thieme ConnectPubMedSuche in Google Scholar
  • 27 Sherman S I, Tielens E T, Ladenson P W. Sucralfate causes malabsorption of L-thyroxine.  Am J Med. 1994;  96 531-535
    CrossrefPubMedSuche in Google Scholar
  • 28 Simon C, Schlienger J L, Chefran J, Studer H. Efficacité de la dexamethasone dans le traitement de l'hyperthyroidie à l'amiodarone.  Presse Med. 1985;  13 2767-2770
    PubMedSuche in Google Scholar
  • 29 Trip M D, Wiersinga W. Incidence, predictability, and pathogenesis of amiodarone-induced thyrotoxicosis and hypothyroidism.  Am J Med. 1991;  91 507-511
    CrossrefPubMedSuche in Google Scholar
  • 30 Wimpfheimer C, Staubli M, Schadelin J, Studer H. Prednisone in amiodarone-induced thyrotoxicosis.  Br Med J. 1982;  284 1835-1836
    PubMedSuche in Google Scholar
  • 31 Wong R, Cheung W, Stockigt J R, Topliss D J. Heterogeneity of amiodarone-induced thyrotoxicosis: evaluation of colour-flow Doppler sonography in predicting therapeutic response.  Intern Med J. 2003;  33 420-426
    CrossrefPubMedSuche in Google Scholar

M.D. Markus Dietlein

Department of Nuclear Medicine
University of Cologne

50924 Cologne

Germany

Telefon: + 492214785856

Fax: + 49 22 14 78 67 77

eMail: markus.dietlein@uni-koeln.de