Cappellani D, Marconcini G, Manetti L, Bartalena L, Bogazzi F. Real-life data on the impact of medical therapy for amiodarone-induced thyrotoxicosis on CV events and hospitalizations.
J Clin Endocrinol Metab 2022;
108:1298-1307. [PMID:
36585895 DOI:
10.1210/clinem/dgac756]
[Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 12/09/2022] [Accepted: 12/28/2022] [Indexed: 01/01/2023]
Abstract
CONTEXT
Patients with amiodarone-induced thyrotoxicosis (AIT) often receive the initial therapy for thyrotoxicosis in several different medical settings before admission to a referral center. Whether the first-line medical therapy (i.e. therapies for thyrotoxicosis at first diagnosis of AIT) affects the outcome of AIT patients is unknown.
STUDY DESIGN
Single-center historical-prospective cohort study of 313 AIT patients.
METHODS
Clinical and biochemical data were collected at first diagnosis, at a referral center, and during the course of AIT. Primary outcomes were cardiovascular events and hospitalizations. First-line therapies were considered appropriate when they included glucocorticoids for type 2 AIT and methimazole for type 1 AIT at the approved dosage, either alone (optimal medical therapy, OMT) or in combination (right-dose combination therapy, RCT). Other therapies were considered not appropriate, including no therapy. Duration of exposure to thyrotoxicosis was the time from first diagnosis of AIT to its remission.
RESULTS
34.5% patients received appropriate therapies (28.1% OMT, 6.4% RCT), whereas the remaining (65.5%) received non-appropriate therapies. Cardiovascular events, and hospitalizations were more frequent in patients who received non-appropriate therapies (33.2% vs 4.5%, and 24.9% vs 6.5%, respectively; p<0.0001 for both). Appropriate therapies reduced serum thyroid hormone concentrations (p=0.018) from first diagnosis to referral, unlike the non-appropriate therapies. The duration of exposure to thyrotoxicosis was longer in patients receiving non-appropriate therapies and was a risk factor for arrhythmias (HR 1.004, p=0.0008), MACEs (HR 1.004, p=0.020) and hospitalizations (HR 1.006, p<.0001).
CONCLUSIONS
The first medical therapy of AIT influences the exposure time to thyrotoxicosis and the occurrence of cardiovascular events and hospitalizations.
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