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Amador F, Mendonça F, da Costa C, Canha M, Neves JS, Pinto R, Amorim S, Souto S, Freitas P, Carvalho D. Total thyroidectomy in a patient awaiting heart transplant with amiodarone-induced thyrotoxicosis: A case report. Clin Case Rep 2023; 11:e6892. [PMID: 36789324 PMCID: PMC9909169 DOI: 10.1002/ccr3.6892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 11/13/2022] [Accepted: 01/03/2023] [Indexed: 02/11/2023] Open
Abstract
Thyroid function may have a severe impact in cardiac function. Herein, we present the case report of a 53-year-old male patient awaiting heart transplant with amiodarone induced thyrotoxicosis that presented a marked improvement of his cardiac function after total thyroidectomy.
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Affiliation(s)
- Filipa Amador
- Department of CardiologyCentro Hospitalar e Universitário de São JoãoPortoPortugal
| | - Fernando Mendonça
- Department of Endocrinology, Diabetes and MetabolismCentro Hospitalar Universitário de São João, Faculty of Medicine e Instituto de Investigação e Inovação em Saude, Universidade do PortoPortoPortugal
| | - Catarina da Costa
- Department of CardiologyCentro Hospitalar e Universitário de São JoãoPortoPortugal
| | - Marta Canha
- Department of Endocrinology, Diabetes and MetabolismCentro Hospitalar Universitário de São João, Faculty of Medicine e Instituto de Investigação e Inovação em Saude, Universidade do PortoPortoPortugal
| | - João Sérgio Neves
- Department of Endocrinology, Diabetes and MetabolismCentro Hospitalar Universitário de São João, Faculty of Medicine e Instituto de Investigação e Inovação em Saude, Universidade do PortoPortoPortugal
| | - Roberto Pinto
- Department of CardiologyCentro Hospitalar e Universitário de São JoãoPortoPortugal
| | - Sandra Amorim
- Department of CardiologyCentro Hospitalar e Universitário de São JoãoPortoPortugal
| | - Selma Souto
- Department of Endocrinology, Diabetes and MetabolismCentro Hospitalar Universitário de São João, Faculty of Medicine e Instituto de Investigação e Inovação em Saude, Universidade do PortoPortoPortugal
| | - Paula Freitas
- Department of Endocrinology, Diabetes and MetabolismCentro Hospitalar Universitário de São João, Faculty of Medicine e Instituto de Investigação e Inovação em Saude, Universidade do PortoPortoPortugal
| | - Davide Carvalho
- Department of Endocrinology, Diabetes and MetabolismCentro Hospitalar Universitário de São João, Faculty of Medicine e Instituto de Investigação e Inovação em Saude, Universidade do PortoPortoPortugal
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de Souza LVF, Campagnolo MT, Martins LCB, Scanavacca MI. Amiodarone-Induced Thyrotoxicosis - Literature Review & Clinical Update. Arq Bras Cardiol 2021; 117:1038-1044. [PMID: 34817015 PMCID: PMC8682089 DOI: 10.36660/abc.20190757] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 09/16/2020] [Accepted: 11/04/2020] [Indexed: 01/21/2023] Open
Abstract
Amiodarone is widely used in treating atrial and ventricular arrhythmias; however, due to its high iodine concentration, the chronic use of the drug can induce thyroid disorders. Amiodarone-induced thyrotoxicosis (AIT) can decompensate and exacerbate underlying cardiac abnormalities, leading to increased morbidity and mortality, especially in patients with left ventricular ejection fraction <30%. AIT cases are classified into two subtypes that guide therapeutic management. The risks and benefits of maintaining the amiodarone must be evaluated individually, and the therapeutic decision should be taken jointly by cardiologists and endocrinologists. Type 1 AIT treatment is similar to that of spontaneous hyperthyroidism, using antithyroid drugs (methimazole and propylthiouracil) at high doses. Type 1 AIT is more complicated since it has proportionally higher recurrences or even non-remission, and definitive treatment is recommended (total thyroidectomy or radioiodine). Type 2 AIT is generally self-limited, yet due to the high mortality associated with thyrotoxicosis in cardiac patients, the treatment should be implemented for faster achievement of euthyroidism. Furthermore, in well-defined cases of type 2 AIT, the treatment with corticosteroids is more effective than treatment with antithyroid drugs. In severe cases, regardless of subtype, immediate restoration of euthyroidism through total thyroidectomy should be considered before the patient progresses to excessive clinical deterioration, as delayed surgery indication is associated with increased mortality.
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Affiliation(s)
| | - Maria Thereza Campagnolo
- Centro Universitário LusiadaFaculdade de Ciências Médicas de SantosSantosSPBrasilCentro Universitário Lusiada Faculdade de Ciências Médicas de Santos, Santos, SP – Brasil
| | - Luiz Claudio Behrmann Martins
- Universidade de São Paulo InstitutoInstituto do Coração - Arrritmia e MarcapassoSão PauloSPBrasilUniversidade de São Paulo Instituto do Coração - Arrritmia e Marcapasso, São Paulo, SP – Brasil
| | - Maurício Ibrahim Scanavacca
- Universidade de São Paulo InstitutoInstituto do Coração - Arrritmia e MarcapassoSão PauloSPBrasilUniversidade de São Paulo Instituto do Coração - Arrritmia e Marcapasso, São Paulo, SP – Brasil
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3
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Troshina EA, Panfilova EA, Mikhina MS, Kim IV, Senyushkina ES, Glibka AA, Shifman BM, Larina AA, Sheremeta MS, Degtyarev MV, Rumyanstsev PO, Kuznetzov NS, Melnichenko GA, Dedov II. [Clinical practice guidelines for acute and chronic thyroiditis (excluding autoimmune thyroiditis)]. ACTA ACUST UNITED AC 2021; 67:57-83. [PMID: 34004104 PMCID: PMC8926135 DOI: 10.14341/probl12747] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 04/12/2021] [Indexed: 01/25/2023]
Abstract
Острые и хронические заболевания щитовидной железы занимают второе место по выявляемости после сахарного диабета. Всемирная организация здравоохранения отмечает ежегодную тенденцию к увеличению числа заболеваний щитовидной железы. В настоящих клинических рекомендациях будут рассмотрены вопросы этиологии, клинического течения, диагностики и лечения острых и хронических (за исключением аутоиммунного) воспалительных заболеваний щитовидной железы.Клинические рекомендации — это основной рабочий инструмент практикующего врача, как специалиста, так и врача узкой практики. Лаконичность, структурированность сведений об определенной нозологии, методов ее диагностики и лечения, базирующихся на принципах доказательной медицины, позволяют в короткий срок дать тот или иной ответ на интересующий вопрос специалисту, добиваться максимальной эффективности и персонализации лечения.Клинические рекомендации составлены профессиональным сообществом узких специалистов, одобрены экспертным советом Министерства здравоохранения РФ. Представленные рекомендации содержат максимально полную информацию, которая требуется на этапе диагностики острых и хронических тиреоидитов, этапе выбора тактики ведения пациентов с тиреоидитом, а также на этапе лечения пациента.Рабочая группа представляет этот проект в профессиональном журнале, посвященном актуальным проблемам эндокринологии, с целью повышения качества оказываемой медицинской помощи, повышения эффективности лечения острых и хронических тиреоидитов путем ознакомления с полным тестом клинических рекомендаций по острым и хроническим тиреоидитам (исключая аутоиммунный тиреоидит) максимально возможного количества специалистов в области не только эндокринологии, но и медицины общей (семейной) практики.
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Affiliation(s)
| | | | | | - I V Kim
- Endocrinology Research Centre
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Ylli D, Wartofsky L, Burman KD. Evaluation and Treatment of Amiodarone-Induced Thyroid Disorders. J Clin Endocrinol Metab 2021; 106:226-236. [PMID: 33159436 DOI: 10.1210/clinem/dgaa686] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 09/28/2020] [Indexed: 01/21/2023]
Abstract
Amiodarone is a class III antiarrhythmic drug containing 37% iodine by weight, with a structure similar to that of thyroid hormones. Deiodination of amiodarone releases large amounts of iodine that can impair thyroid function, causing either hypothyroidism or thyrotoxicosis in susceptible individuals reflecting ~20% of patients administered the drug. Not only the excess iodine, but also the amiodarone (or its metabolite, desethylamiodarone) itself may cause thyroid dysfunction by direct cytotoxicity on thyroid cells. We present an overview of the epidemiology and pathophysiology of amiodarone-induced thyroid disorders, with a focus on the various forms of clinical presentation and recommendations for personalized management of each form.
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Affiliation(s)
- Dorina Ylli
- Endocrine Section, MedStar Washington Hospital Center, Washington, DC
- Faculty of Medicine, University of Medicine, Tirana, Albania
| | - Leonard Wartofsky
- Endocrine Section, MedStar Washington Hospital Center, Washington, DC
| | - Kenneth D Burman
- Endocrine Section, MedStar Washington Hospital Center, Washington, DC
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Abstract
Amiodarone-induced thyrotoxicosis (AIT) are not uncommon endocrinopathies. Clinicians are sometimes faced with difficult diagnostic and therapeutic situations. The disease pathophysiology is partially understood, explaining the lack of predictive factors for occurrence. Different international recommendations for their management have been published: the most recent in 2018 by the European Thyroid Association (ETA) (Ross et al., 2016; Bartalena et al., 2018). The purpose of this paper is to present the essential concepts for their management and to review the literature since 2018.
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Tauveron I, Batisse-Lignier M, Maqdasy S. [Challenges in the management of amiodarone-induced thyrotoxicosis]. Presse Med 2018; 47:746-756. [PMID: 30274916 DOI: 10.1016/j.lpm.2018.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 07/30/2018] [Accepted: 09/05/2018] [Indexed: 11/28/2022] Open
Abstract
Amiodarone, a benzofuranic iodine-rich pan antiarrhythmic drug, is frequently associated with thyroid dysfunction. This side effect is heterogeneous and unpredicted, motivating regular evaluation of thyroid function tests. In contrary to hypothyroidism, amiodarone-induced thyrotoxicosis (AIT) is a challenging situation owing to the risk of deterioration of the general and cardiac status of such debilitating patients. Classically, AIT is either an iodine-induced thyrotoxicosis in patients with an abnormal thyroid (type I), or due to a subacute thyroiditis on a "healthy" thyroid (type II). Even if many studies tried to better identify the types of AIT, the diagnostic dilemma of type of AIT could be present, and many patients are treated by an association of antithyroid drugs (useful for type I AIT) with corticoids (useful for type II AIT). Being the main etiological factor in AIT, amiodarone is supposed to be stopped, but it could remain the only anti-arrhythmic option that is needed to be either continued or reintroduced to improve the cardiovascular survival. Recently, many studies demonstrated that amiodarone could be continued or reintroduced in patients with history of type II AIT. Nevertheless, in the other patients, amiodarone maintenance complicates the therapeutic response to the antithyroid drugs and increases the risk of AIT recurrence. Thus, amiodarone therapy is preferred to be interrupted. In such patients, thyroid ablation is recommended once AIT is under control.
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Affiliation(s)
- Igor Tauveron
- CHU Clermont-Ferrand, service d'endocrinologie, diabétologie et maladies métaboliques, 63003 Clermont-Ferrand, France; Laboratoire GReD : UMR université Clermont Auvergne-CNRS 6293, Inserm U1103, BP 10448, 63177 Aubiere, France.
| | - Marie Batisse-Lignier
- CHU Clermont-Ferrand, service d'endocrinologie, diabétologie et maladies métaboliques, 63003 Clermont-Ferrand, France; Laboratoire GReD : UMR université Clermont Auvergne-CNRS 6293, Inserm U1103, BP 10448, 63177 Aubiere, France
| | - Salwan Maqdasy
- CHU Clermont-Ferrand, service d'endocrinologie, diabétologie et maladies métaboliques, 63003 Clermont-Ferrand, France; Laboratoire GReD : UMR université Clermont Auvergne-CNRS 6293, Inserm U1103, BP 10448, 63177 Aubiere, France
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Trohman RG, Sharma PS, McAninch EA, Bianco AC. Amiodarone and thyroid physiology, pathophysiology, diagnosis and management. Trends Cardiovasc Med 2018; 29:285-295. [PMID: 30309693 DOI: 10.1016/j.tcm.2018.09.005] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 08/15/2018] [Accepted: 09/06/2018] [Indexed: 12/14/2022]
Abstract
Although amiodarone is considered the most effective antiarrhythmic agent, its use is limited by a wide variety of potential toxicities. The purpose of this review is to provide a comprehensive "bench to bedside" overview of the ways amiodarone influences thyroid function. We performed a systematic search of MEDLINE to identify peer-reviewed clinical trials, randomized controlled trials, meta-analyses, and other clinically relevant studies. The search was limited to English-language reports published between 1950 and 2017. Amiodarone was searched using the terms adverse effects, hypothyroidism, myxedema, hyperthyroidism, thyroid storm, atrial fibrillation, ventricular arrhythmia, and electrical storm. Google and Google scholar as well as bibliographies of identified articles were reviewed for additional references. We included 163 germane references in this review. Because amiodarone is one of the most frequently prescribed antiarrhythmic drugs in the United States, the mechanistic, diagnostic and therapeutic information provided is relevant for practicing clinicians in a wide range of medical specialties.
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Affiliation(s)
- Richard G Trohman
- Divisions of Cardiology and Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, Rush University Medical Center, Chicago, IL, United States.
| | - Parikshit S Sharma
- Divisions of Cardiology and Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, Rush University Medical Center, Chicago, IL, United States
| | - Elizabeth A McAninch
- Divisions of Cardiology and Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, Rush University Medical Center, Chicago, IL, United States
| | - Antonio C Bianco
- Divisions of Cardiology and Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, Rush University Medical Center, Chicago, IL, United States
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Maqdasy S, Benichou T, Dallel S, Roche B, Desbiez F, Montanier N, Batisse-Lignier M, Tauveron I. Issues in amiodarone-induced thyrotoxicosis: Update and review of the literature. ANNALES D'ENDOCRINOLOGIE 2018; 80:54-60. [PMID: 30236455 DOI: 10.1016/j.ando.2018.05.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Revised: 04/18/2018] [Accepted: 05/13/2018] [Indexed: 11/15/2022]
Abstract
Amiodarone, a benzofuranic iodine-rich pan-anti-arrhythmic drug, induces amiodarone-induced thyrotoxicosis (AIT) in 7-15% of patients. AIT is a major issue due to its typical severity and resistance to anti-thyroid measures, and to its negative impact on cardiac status. Classically, AIT is either an iodine-induced thyrotoxicosis in patients with abnormal thyroid (type 1), or due to acute thyroiditis in a "healthy" thyroid (type 2). Determination of the type of AIT is a diagnostic dilemma, as characteristics of both types may be present in some patients. As it is the main etiological factor in AIT, it is recommended that amiodarone treatment should be stopped; however, it may be the only anti-arrhythmic option, needing to be either continued or re-introduced to improve cardiovascular survival. Recently, a few studies demonstrated that amiodarone could be continued or re-introduced in patients with history of type-2 AIT. However, in the other patients, it is recommended that amiodarone treatment be interrupted, to improve response to thioamides and to alleviate the risk of AIT recurrence. In such patients, thyroidectomy is recommended once AIT is under control, allowing safe re-introduction of amiodarone.
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Affiliation(s)
- Salwan Maqdasy
- Service d'endocrinologie, diabétologie et maladies métaboliques, CHU Clermont-Ferrand, 63003 Clermont-Ferrand, France; Laboratoire GReD, UMR Université Clermont Auvergne-CNRS 6293, Inserm U1103, BP 10448, 63177 Aubière, France.
| | - Thomas Benichou
- Service d'endocrinologie, diabétologie et maladies métaboliques, CHU Clermont-Ferrand, 63003 Clermont-Ferrand, France
| | - Sarah Dallel
- Service d'endocrinologie, diabétologie et maladies métaboliques, CHU Clermont-Ferrand, 63003 Clermont-Ferrand, France
| | - Béatrice Roche
- Service d'endocrinologie, diabétologie et maladies métaboliques, CHU Clermont-Ferrand, 63003 Clermont-Ferrand, France
| | - Françoise Desbiez
- Service d'endocrinologie, diabétologie et maladies métaboliques, CHU Clermont-Ferrand, 63003 Clermont-Ferrand, France
| | - Nathanaëlle Montanier
- Service d'endocrinologie, diabétologie et maladies métaboliques, CHU Clermont-Ferrand, 63003 Clermont-Ferrand, France
| | - Marie Batisse-Lignier
- Service d'endocrinologie, diabétologie et maladies métaboliques, CHU Clermont-Ferrand, 63003 Clermont-Ferrand, France; Laboratoire GReD, UMR Université Clermont Auvergne-CNRS 6293, Inserm U1103, BP 10448, 63177 Aubière, France
| | - Igor Tauveron
- Service d'endocrinologie, diabétologie et maladies métaboliques, CHU Clermont-Ferrand, 63003 Clermont-Ferrand, France; Laboratoire GReD, UMR Université Clermont Auvergne-CNRS 6293, Inserm U1103, BP 10448, 63177 Aubière, France
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Bartalena L, Bogazzi F, Chiovato L, Hubalewska-Dydejczyk A, Links TP, Vanderpump M. 2018 European Thyroid Association (ETA) Guidelines for the Management of Amiodarone-Associated Thyroid Dysfunction. Eur Thyroid J 2018; 7:55-66. [PMID: 29594056 PMCID: PMC5869486 DOI: 10.1159/000486957] [Citation(s) in RCA: 113] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 01/16/2018] [Indexed: 01/16/2023] Open
Abstract
Treatment with amiodarone is associated with changes in thyroid function tests, but also with thyroid dysfunction (amiodarone-induced hypothyroidism, AIH, and amiodarone-induced thyrotoxicosis, AIT). Both AIH and AIT may develop in apparently normal thyroid glands or in the presence of underlying thyroid abnormalities. AIH does not require amiodarone withdrawal, and is treated with levothyroxine replacement if overt, whereas subclinical forms may be followed without treatment. Two main types of AIT are recognized: type 1 AIT (AIT 1), a form of iodine-induced hyperthyroidism occurring in nodular goitres or latent Graves disease, and type 2 AIT (AIT 2), resulting from destructive thyroiditis in a normal thyroid gland. Mixed/indefinite forms exist due to both pathogenic mechanisms. AIT 1 is best treated with thionamides that may be combined for a few weeks with sodium perchlorate to make the thyroid gland more sensitive to thionamides. AIT 2 is treated with oral glucocorticoids. Once euthyroidism has been restored, AIT 2 patients are followed up without treatment, whereas AIT 1 patients should be treated with thyroidectomy or radioiodine. Mixed/indefinite forms of AIT are treated with thionamides. Oral glucocorticoids can be added from the beginning if a precise diagnosis is uncertain, or after a few weeks if response to thionamides alone is poor. The decision to continue or to stop amiodarone in AIT should be individualized in relation to cardiovascular risk stratification and taken jointly by specialist cardiologists and endocrinologists. In the presence of rapidly deteriorating cardiac conditions, emergency thyroidectomy may be required for all forms of AIT.
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Affiliation(s)
- Luigi Bartalena
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
- *Prof. Luigi Bartalena, Department of Medicine and Surgery, University of Insubria, Endocrine Unit, ASST dei Sette Laghi, Viale Borri 57, IT–21100 Varese (Italy), E-Mail
| | - Fausto Bogazzi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Luca Chiovato
- Unit of Internal Medicine and Endocrinology, Istituti Clinici Scientifici Maugeri and University of Pavia, Pavia, Italy
| | | | - Thera P. Links
- Department of Endocrinology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Isaacs M, Costin M, Bova R, Barrett HL, Heffernan D, Samaras K, Greenfield JR. Management of Amiodarone-Induced Thyrotoxicosis at a Cardiac Transplantation Centre. Front Endocrinol (Lausanne) 2018; 9:482. [PMID: 30186240 PMCID: PMC6113588 DOI: 10.3389/fendo.2018.00482] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 08/03/2018] [Indexed: 12/22/2022] Open
Abstract
Background: Amiodarone-induced thyrotoxicosis (AIT) is associated with significant morbidity and mortality, particularly in patients with cardiac failure. The aim of the study was to evaluate the management of AIT at a tertiary hospital specialising in cardiac failure and transplantation. Methods: Retrospective audit of 66 patients treated for AIT by Endocrinology (2007-2016), classified as type 1 (T1) or type 2 (T2) based on radiological criteria. Main outcome measurements were response rate to initial treatment, time to euthyroidism, and frequency/safety of thyroidectomy. Results: Mean age was 60 ± 2 years; 80% were male. Sixty-four patients commenced medical treatment: thionamides (THIO) in 23, glucocorticoids (GC) in 17 and combination (COMB) in 24. Median thyroxine (fT4) was 35.1 (31.2-46.7) in THIO, 43.1 (30.4 -60.7) in GC, and 60.0 (39.0 ->99.9) pmol/L in COMB (p = 0.01). Initial therapy induced euthyroidism in 52%: 70% THIO, 53% GC, and 33% COMB (p = 0.045) by 100 (49-167), 47 (35-61), and 53 (45-99) days, respectively (p = 0.02). A further 11% became euthyroid after transitioning from monotherapy to COMB. Thyroidectomy was undertaken in 33%. Patients who underwent thyroidectomy were younger (54 ± 3 vs. 63 ± 2 years; p = 0.03), with higher prevalence of severely impaired left ventricular function prior to diagnosis of AIT (38 vs. 18%; p = 0.08). Despite median American Society of Anaesthesiologists classification 4, no thyroidectomy patient experienced cardiorespiratory complications/death. Conclusions: Patients with AIT had limited response to medical treatment. The poorest response was observed in COMB group, likely related to greater hyperthyroidism severity. Thyroidectomy is safe in patients with severe cardiac failure if performed in a centre with cardiac anaesthetic expertise. There should be low threshold for proceeding to thyroidectomy in patients with severe AIT and/or cardiac failure.
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Affiliation(s)
- Michelle Isaacs
- Department of Endocrinology, St Vincent's Hospital Sydney, Darlinghurst, NSW, Australia
- *Correspondence: Michelle Isaacs
| | - Monique Costin
- Northern Sydney Endocrine Centre, Sydney, NSW, Australia
- Faculty of Medicine, University of Notre Dame, Sydney, NSW, Australia
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Ron Bova
- Faculty of Medicine, University of Notre Dame, Sydney, NSW, Australia
- Department of Ear Nose and Throat Surgery, St Vincent's Hospital Sydney, Darlinghurst, NSW, Australia
| | - Helen L. Barrett
- Department of Obstetric Medicine, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Drew Heffernan
- Department of Anaesthetics, St Vincent's Hospital Sydney, Darlinghurst, NSW, Australia
| | - Katherine Samaras
- Department of Endocrinology, St Vincent's Hospital Sydney, Darlinghurst, NSW, Australia
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
- Diabetes and Metabolism Division, Garvan Institute of Medical Research, Sydney, NSW, Australia
| | - Jerry R. Greenfield
- Department of Endocrinology, St Vincent's Hospital Sydney, Darlinghurst, NSW, Australia
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
- Diabetes and Metabolism Division, Garvan Institute of Medical Research, Sydney, NSW, Australia
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Lebedeva EA, Iablonskaia IA, Bulgakova SV. Amiodarone-induced thyrotoxicosis: state of the art. ACTA ACUST UNITED AC 2017. [DOI: 10.14341/ket2017231-38] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
В обзоре представлены данные литературы последних лет о патогенезе, диагностике, лечении амиодарон-индуцированного тиреотоксикоза (АИТ), который является частым осложнением терапии амиодароном (Ам). Описаны изменения секреции и метаболизма тиреоидныхгомонов под влиянием кратковременной и длительной терапии Ам. Развитие АИТ всегда приводит к ухудшению течения аритмии, усугублению недостаточности кровообращения, утяжелению состояния пациента. Выделяют АИТ 1 типа и АИТ 2 типа, а также смешанную форму. Описаны диагностические критерии АИТ 1 и 2 типа. Наиболее информативным тестом для дифференциальной диагностики АИТ 1, 2 типов и смешанных форм является сонография щитовидной железы с допплеровским исследованием кровотока и сканирование с 99mTc-sestaMIBI. Тактика лечения определяется типом АИТ, состоянием сердечно-сосудистой системы, риском повторных аритмий. Консервативное лечение зависит от типа АИТ и осуществляется тиреостатиками или глюкокортикоидами. Обсуждается возможность продолжения антиаритмической терапии Ам у пациентов, перенесших АИТ. При АИТ 1 типа и смешанной форме требуется отмена препарата, если это невозможно – радикальное лечение тиреотоксикоза (радиойодтерапия, тиреоидэктомия). АИТ 2 типа является самолимитирующимся процессом, при жизненно угрожающих аритмиях прием Ам может быть продолжен. Показана эффективность радиойодтерапии для радикального лечения тиреотоксикоза при АИТ 1 и 2 типа, несмотря на низкий захват радиойода. Однако этот вопрос требует дальнейшего изучения и обсуждения. Для быстрого восстановления эутиреоза у тяжелых больных применяют плазмаферез и тиреоидэктомию.
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Wang J, Zhang R. Evaluation of 99mTc-MIBI in thyroid gland imaging for the diagnosis of amiodarone-induced thyrotoxicosis. Br J Radiol 2017; 90:20160836. [PMID: 28106465 DOI: 10.1259/bjr.20160836] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE Amiodarone-induced thyrotoxicosis (AIT) is caused by amiodarone as a side effect of cardiovascular disease treatment. Based on the differences in their pathological and physiological mechanisms, many methods have been developed so far to differentiate AIT subtypes such as colour flow Doppler sonography (CFDS) and 24-h radioiodine uptake (RAIU). However, these methods suffer from inadequate accuracy in distinguishing different types of AITs and sometimes lead to misdiagnosis and delayed treatments. Therefore, there is an unmet demand for an efficient method for accurate classification of AIT. METHODS Technetium-99 methoxyisobutylisonitrile (99mTc-MIBI) thyroid imaging was performed on 15 patients for AIT classification, and the results were compared with other conventional methods such as CFDS, RAIU and 99mTcO4 imaging. RESULTS High uptake and retention of MIBI in thyroid tissue is characteristic in Type I AIT, while in sharp contrast, low uptake of MIBI in the thyroid tissue was observed in Type II AIT. Mixed-type AIT shows uptake value between Types I and II. MIBI imaging outperforms other methods with a lower misdiagnosis rate. CONCLUSION Among the methods evaluated, MIBI imaging enables an accurate identification of Type I, II and mixed-type AITs by showing distinct images for different types of AITs. The results obtained from our selected subjects revealed that MIBI imaging is a reliable method for diagnosis and classification of AITs and MIBI imaging has potential in the treatment of thyroid diseases. Advances in knowledge: 99mTc-MIBI imaging is a useful method for the diagnosis of AIT. It can distinguish different types of AITs especially for mixed-type AIT, which is usually difficult to treat. 99mTc-MIBI has potential advantages over conventional methods in the efficient treatment of AIT.
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Affiliation(s)
- Junqi Wang
- Department of Nuclear Medicine, Tianjin First Central Hospital, Tianjin, China
| | - Ruiguo Zhang
- Department of Nuclear Medicine, Tianjin First Central Hospital, Tianjin, China
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Wang AG, Cheng HC. Amiodarone-Associated Optic Neuropathy: Clinical Review. Neuroophthalmology 2016; 41:55-58. [PMID: 28348626 DOI: 10.1080/01658107.2016.1247461] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 10/09/2016] [Accepted: 10/09/2016] [Indexed: 10/20/2022] Open
Abstract
Amiodarone, an antiarrhythmic agent, has been associated with visual loss secondary to optic neuropathy. The reported mean duration of amiodarone use before visual loss is about 9 months. Patients receiving amiodarone have a 2-fold increased risk of developing optic neuropathy, especially in males and possibly in patients with longer duration of treatment. Amiodarone-associated optic neuropathy is characterised by an insidious onset, slow progression, bilateral simultaneous visual loss, and protracted disc swelling. After discontinuing amiodarone use, visual acuity and visual field deficits tend to improve or stabilise in most patients, with about 20% of the patients getting worse.
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Affiliation(s)
- An-Guor Wang
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Ophthalmology, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Hui-Chen Cheng
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Ophthalmology, School of Medicine, National Yang-Ming University, Taipei, Taiwan
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