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Aubry Y, Dosch M, Donath MY. Cardiac evaluation in amiodarone-induced thyroid dysfunction with suspected cardiac ischemia?: a case report and review of the literature. J Med Case Rep 2024; 18:235. [PMID: 38698496 PMCID: PMC11064290 DOI: 10.1186/s13256-024-04552-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 04/08/2024] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND Amiodarone-induced thyroid dysfunction (AIT) is a side-effect associated with the use of Amiodarone for the treatment of refractory arrythmias. Resulting hyperthyroidism can precipitate cardiac complications, including cardiac ischemia and myocardial infarction, although this has only been described in a few case reports. CASE PRESENTATION We present here a clinical scenario involving a 66-year-old male Caucasian patient under Amiodarone for atrial fibrillation, who developed AIT. In the presence of dyspnea, multiple cardiovascular risk factors and ECG abnormalities, a transthoracic echocardiogram was performed, showing inferobasal hypokinesia. This led to further investigations through a cardiac PET-CT, where cardiac ischemia was suspected. Ultimately, the coronary angiography revealed no abnormalities. Nonetheless, these extensive cardiologic investigations led to a delay in initiating an emergency endovascular revascularization for acute-on-chronic left limb ischemia. Although initial treatment using Carbimazole was not successful after three weeks, the patient reached euthyroidism after completion of the treatment with Prednisone so that eventually thyroidectomy was not performed. Endovascular revascularization was finally performed after more than one month. CONCLUSIONS We discuss here cardiac abnormalities in patients with AIT, which may be due to relative ischemia secondary to increased metabolic demand during hyperthyroidism. Improvement of cardiac complications is expected through an optimal AIT therapy including medical therapy as the primary approach and, when necessary, thyroidectomy. Cardiac investigations in the context of AIT should be carefully considered and may not justify delaying other crucial interventions. If considered mandatory, diagnostic procedures such as coronary angiography should be preferred to functional testing.
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Affiliation(s)
- Yoann Aubry
- Clinic of Endocrinology, Diabetes and Metabolism, Hospital Delémont, Hôpital du Jura, Faubourg Des Capucins 30, 2800, Delémont, Switzerland.
- Clinic of Endocrinology, Diabetes and Metabolism, University Hospital Basel, Basel, Switzerland.
| | - Michel Dosch
- The Division of Digestive Surgery, Surgery Department, University Hospitals of Geneva, Geneva, Switzerland
| | - Marc Y Donath
- Clinic of Endocrinology, Diabetes and Metabolism, University Hospital Basel, Basel, Switzerland
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2
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Egan S, Collins-Smyth C, Chitnis S, Head J, Chiu A, Bhatti G, McLean SR. Prevention of postoperative atrial fibrillation in cardiac surgery: a quality improvement project. Can J Anaesth 2023; 70:1880-1891. [PMID: 37919634 PMCID: PMC10709480 DOI: 10.1007/s12630-023-02619-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 06/23/2023] [Accepted: 07/02/2023] [Indexed: 11/04/2023] Open
Abstract
PURPOSE Postoperative atrial fibrillation (POAF) has an incidence of 20-60% in cardiac surgery. The Society of Cardiovascular Anesthesiologists and the European Association of Cardiothoracic Anaesthesiology Practice Advisory have recommended postoperative beta blockers and amiodarone for the prevention of POAF. By employing quality improvement (QI) strategies, we sought to increase the use of these agents and to reduce the incidence of POAF among our patients undergoing cardiac surgery. METHODS This single-centre QI initiative followed the traditional Plan, Do, Study, Act (PDSA) cycle scientific methodology. A POAF risk score was developed to categorize all patients undergoing cardiac surgery as either normal or elevated risk. Risk stratification was incorporated into a preprinted prescribing guide, which recommended postoperative beta blockade for all patients and a postoperative amiodarone protocol for patients with elevated risk starting on postoperative day one (POD1). A longitudinal audit of all patients undergoing cardiac surgery was conducted over 11 months to track the use of prophylactic medications and the incidence of POAF. RESULTS Five hundred and sixty patients undergoing surgery were included in the QI initiative from 1 December 2020 to 1 November 2021. The baseline rate of POAF across all surgical subtypes was 39% (198/560). The use of prophylactic amiodarone in high-risk patients increased from 13% (1/8) at the start of the project to 41% (48/116) at the end of the audit period. The percentage of patients receiving a beta blocker on POD1 did fluctuate, but remained essentially unchanged throughout the audit (34.8% in December 2020 vs 46.7% in October 2021). After 11 months, the overall incidence of POAF was 29% (24.9% relative reduction). Notable reductions in the incidence of POAF were observed in more complex surgical subtypes by the end of the audit, including multiple valve replacement (89% vs 56%), aortic repair (50% vs 33%), and mitral valve surgery (45% vs 33%). CONCLUSIONS This single-centre QI intervention increased the use of prophylactic amiodarone by 28% for patients at elevated risk of POAF, with no change in the early postoperative initiation of beta blockers (46.7% of patients by POD1). There was a notable reduction in the incidence of POAF in patients at elevated risk undergoing surgery.
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Affiliation(s)
- Sinead Egan
- Vancouver Acute Department of Anesthesia, Vancouver General Hospital, Vancouver, BC, Canada
| | - Coilin Collins-Smyth
- Vancouver Acute Department of Anesthesia, Vancouver General Hospital, Vancouver, BC, Canada
| | - Shruti Chitnis
- Vancouver Acute Department of Anesthesia, Vancouver General Hospital, Vancouver, BC, Canada
| | - Jamie Head
- Department of A;nesthesiology, Pharmacology & Therapeutics, The University of British Columbia, Vancouver, BC, Canada
| | - Allison Chiu
- Vancouver Coastal Health, Vancouver General Hospital, Vancouver, BC, Canada
| | - Gurdip Bhatti
- Cardiac Sciences, Vancouver General Hospital, Vancouver, BC, Canada
| | - Sean R McLean
- Vancouver Acute Department of Anesthesia, Vancouver General Hospital, Vancouver, BC, Canada.
- Vancouver Acute Department of Anesthesia and Perioperative Medicine, Vancouver General Hospital, JPP3 Room 3400, 899 West 12th Ave, Vancouver, BC, V5Z 1M9, Canada.
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Wang Z, Li X, Zou Y, Li X, Lv Q. Combination of Rivaroxaban and Amiodarone Increases Bleeding in Patients With Atrial Fibrillation. Ann Pharmacother 2023:10600280231211306. [PMID: 37960871 DOI: 10.1177/10600280231211306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Rivaroxaban and amiodarone are commonly used for treating patients with atrial fibrillation. Drug-drug interactions between rivaroxaban and amiodarone may increase exposure to rivaroxaban. However, the clinical relevance of this drug-drug interaction is still not clear. OBJECTIVE The aim was to investigate the risk of bleeding in patients receiving a combination of rivaroxaban and amiodarone. METHODS This was a prospective observational study in which we included atrial fibrillation patients treated with rivaroxaban. The patients were divided into the rivaroxaban group and the combination of rivaroxaban and amiodarone group (the combination group). Propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) were performed to adjust between-group differences. The primary endpoint was defined as the time to the first occurrence of a composite of major, clinically relevant nonmajor, and minor bleeding. RESULTS In total, 481 atrial fibrillation patients were included in the analysis. After PSM, 154 patients in the rivaroxaban group were matched with 154 patients in the combination group. The bleeding events mainly consisted of clinically relevant nonmajor and minor bleeding. Only one patient experienced major bleeding. The primary outcome was recorded in 26.0% of patients in the combination group and 10.4% of patients in the rivaroxaban group (hazard ratio = 2.76, 95% CI = 1.55-4.93, P < 0.001). The bleeding risk was significantly higher in the combination group compared with that in the rivaroxaban group in the IPTW and stabilized IPTW analyses (hazard ratio = 2.17, 95% CI = 1.32-3.56, P = 0.002). CONCLUSION AND RELEVANCE The combination of rivaroxaban and amiodarone increased the risk of bleeding in patients with atrial fibrillation, especially clinically relevant nonmajor and minor bleeding. Physicians prescribing rivaroxaban and amiodarone together should be concerned about an increase in the risk of nonmajor bleeding.
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Affiliation(s)
- Zi Wang
- Department of Pharmacy, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xiaoyu Li
- Department of Pharmacy, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Ye Zou
- Department of Pharmacy, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xiaoye Li
- Department of Pharmacy, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Qianzhou Lv
- Department of Pharmacy, Zhongshan Hospital, Fudan University, Shanghai, China
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4
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Gašparini D, Raljević D, Pehar-Pejčinović V, Klarica Gembić T, Peršić V, Turk Wensveen T. When amiodarone-induced thyroiditis meets cardiomyopathy with excessive trabeculation: a case report. Front Cardiovasc Med 2023; 10:1212965. [PMID: 37547257 PMCID: PMC10401478 DOI: 10.3389/fcvm.2023.1212965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 07/10/2023] [Indexed: 08/08/2023] Open
Abstract
Introduction Amiodarone is a potent antiarrhythmic medication used to treat life-threatening ventricular arrhythmias; however, its well-established adverse effect is a thyroid disorder. Amiodarone-induced thyroiditis (AIT), a clinical entity involving two types with different etiopathology and treatment approaches, may occur at the beginning or even several years after amiodarone treatment discontinuation. The toxicity profile of amiodarone becomes especially important in young patients with lifelong cardiac disorders, which are often refractory to other antiarrhythmic drugs. Herein, we report the first case of non-sustained ventricular tachycardia (NSVT), an unusual presentation of type II AIT, in a young male patient who was previously diagnosed with left ventricular cardiomyopathy with excessive trabeculation. Case report A 36-year-old male non-athlete presented with tiredness during regular follow-up. Continuous electrocardiographic monitoring (cECG) revealed NSVT, whereas echocardiography and cardiac magnetic resonance imaging detected discrete structural and functional changes that could not fully explain the observed cECG report. Conversely, an unmeasurably low thyrotropin level on admission and previous exposure to amiodarone pointed the diagnostic pathway in the direction of the thyroid gland. Elevated free thyroxine and undetectable autoantibody titers with unremarkable sonographic findings raised clinical suspicion of type II AIT. Scintigraphic imaging with 99mTc-2-methoxyisobutylisonitrile (sestamibi) revealed decreased thyroid uptake; hence, prednisone was introduced for treatment. Clear improvements in both biochemical and electrocardiographic parameters were observed after immunomodulatory treatment of type II AIT in this young patient with cardiomyopathy and excessive trabeculation. Conclusion Treatment of reversible causes of cardiac rhythm abnormalities such as type II AIT should be considered before choosing other treatment modalities, particularly in patients with structural cardiac disorders. The importance of a multidisciplinary approach in complex cases such as the one reported, thus, cannot be emphasized enough.
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Affiliation(s)
- Dora Gašparini
- Department of Histology and Embryology, Faculty of Medicine, University of Rijeka, Rijeka, Croatia
- Center for Diabetes, Endocrinology and Cardiometabolism, Hospital for Medical Rehabilitation of the Heart and Lung Diseases and Rheumatism Thalassotherapia Opatija, Opatija, Croatia
| | - Damir Raljević
- Department of Rehabilitation and Sports Medicine, Faculty of Medicine, University of Rijeka, Rijeka, Croatia
- Division of Cardiology, Hospital for Medical Rehabilitation of the Heart and Lung Diseases and Rheumatism Thalassotherapia Opatija, Opatija, Croatia
| | - Vesna Pehar-Pejčinović
- Department of Rehabilitation and Sports Medicine, Faculty of Medicine, University of Rijeka, Rijeka, Croatia
- Division of Cardiology, Hospital for Medical Rehabilitation of the Heart and Lung Diseases and Rheumatism Thalassotherapia Opatija, Opatija, Croatia
| | | | - Viktor Peršić
- Department of Rehabilitation and Sports Medicine, Faculty of Medicine, University of Rijeka, Rijeka, Croatia
- Division of Cardiology, Hospital for Medical Rehabilitation of the Heart and Lung Diseases and Rheumatism Thalassotherapia Opatija, Opatija, Croatia
| | - Tamara Turk Wensveen
- Center for Diabetes, Endocrinology and Cardiometabolism, Hospital for Medical Rehabilitation of the Heart and Lung Diseases and Rheumatism Thalassotherapia Opatija, Opatija, Croatia
- Department of Internal Medicine, Faculty of Medicine, University of Rijeka, Rijeka, Croatia
- Department of Endocrinology, Diabetes and Metabolic Diseases, Clinic of Internal Medicine, Clinical Hospital Center Rijeka, Rijeka, Croatia
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Sande CM, Tondi Resta I, Livolsi VA. The Thyroid Pathologist Meets Therapeutic Pharmacology. Endocr Pathol 2023; 34:48-56. [PMID: 36723855 PMCID: PMC9890439 DOI: 10.1007/s12022-023-09749-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/10/2023] [Indexed: 02/02/2023]
Abstract
The effects of many pharmacological agents on thyroid function are well known. Direct influences on measurements of thyroid function tests are also described. However, certain classes of drugs produce morphological changes in the gland. This review focuses on the significance of the following drug classes for the thyroid pathologist: iodine, antithyroid drugs, psychotropic drugs, antibiotics, cardiotropic drugs, antidiabetic drugs, and immunomodulatory agents. Radioactive iodine initially induces mild histologic changes; however, the long-term effects include marked follicular atrophy, fibrosis, and nuclear atypia-changes that vary depending on the pre-therapy condition of the gland. Some psychotropic drugs have been associated with a spectrum of inflammatory changes throughout the gland. The tetracycline class of antibiotics, namely minocycline, can lead to a grossly black thyroid gland with pigment seen in both colloid and follicular epithelial cells while variably present within thyroid nodules. The surgical pathologist most commonly sees an amiodarone-affected gland removed for hyperthyroidism, and the histologic findings again depend on the pre-therapy condition of the gland. While GLP-1 receptor agonists carry an FDA black box warning for patients with a personal or family history of multiple endocrine neoplasia or medullary thyroid carcinoma, the C cell hyperplasia originally noted in rats has not borne out in human studies. Finally, thyroiditis and hypothyroidism are well known complications of checkpoint inhibitor therapy, and rare cases of severe thyroiditis requiring urgent thyroidectomy have been reported with unique histologic findings. In this review, we describe the histologic findings for these drugs and more, in many cases including their functional consequences.
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Affiliation(s)
- Christopher M Sande
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, 3400 Spruce Street, 6 Founders Building, Philadelphia, PA, 19104, USA
| | - Isabella Tondi Resta
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, 3400 Spruce Street, 6 Founders Building, Philadelphia, PA, 19104, USA
| | - Virginia A Livolsi
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, 3400 Spruce Street, 6 Founders Building, Philadelphia, PA, 19104, USA.
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Bílek R, Danzig V, Grimmichová T. Antiviral activity of amiodarone in SARS-CoV-2 disease. Physiol Res 2022. [DOI: 10.33549/physiolres.934974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Amiodarone seems to exhibit some antiviral activity in the disease caused by SARS-CoV-2. Here we have examined the SARS-CoV-2 disease course in the entire population of the Czech Republic and compared it with the course of the disease in patients treated with amiodarone in two major Prague’s hospitals. In the whole population of the Czech Republic SARS-CoV-2 infected 1665070 persons (15.6 %) out of 10694000 (100 %) between 1 April 2020 and 30 June 2021. In the same time period only 35 patients (3.4 %) treated with amiodarone were infected with SARS-CoV-2 virus out of 1032 patients (100 %) who received amiodarone. It appears that amiodarone can prevent SARS-CoV-2 virus infection by multiple mechanisms. In in-vitro experiments it exhibits SARS-CoV-2 virus replication inhibitions. Due to its anti-inflammatory and antioxidant properties, it may have beneficial effect on the complications caused by SARS-CoV-2 as well. Additionally, inorganic iodine released from amiodarone can be converted to hypoiodite (IO-), which has antiviral and antibacterial activity, and thus can affect the life cycle of the virus.
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Affiliation(s)
- R Bílek
- Institute of Endocrinology, Národní 8, 110 00 Prague 1, Czech Republic. ,
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7
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Song Y, Guo T, Jiang Y, Zhu M, Wang H, Lu W, Jiang M, Qi M, Lan F, Cui M. KCNQ1-deficient and KCNQ1-mutant human embryonic stem cell-derived cardiomyocytes for modeling QT prolongation. Stem Cell Res Ther 2022; 13:287. [PMID: 35765105 PMCID: PMC9241307 DOI: 10.1186/s13287-022-02964-3] [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: 01/11/2022] [Accepted: 03/20/2022] [Indexed: 11/10/2022] Open
Abstract
Background The slowly activated delayed rectifier potassium current (IKs) mediated by the KCNQ1 gene is one of the main currents involved in repolarization. KCNQ1 mutation can result in long-QT syndrome type 1 (LQT1). IKs does not participate in repolarization in mice; thus, no good model is currently available for research on the mechanism of and drug screening for LQT1. In this study, we established a KCNQ1-deficient human cardiomyocyte (CM) model and performed a series of microelectrode array (MEA) detection experiments on KCNQ1-mutant CMs constructed in other studies to explore the pathogenic mechanism of KCNQ1 deletion and mutation and perform drug screening. Method KCNQ1 was knocked out in human embryonic stem cell (hESC) H9 line using the CRISPR/cas9 system. KCNQ1-deficient and KCNQ1-mutant hESCs were differentiated into CMs through a chemically defined differentiation protocol. Subsequently, high-throughput MEA analysis and drug intervention were performed to determine the electrophysiological characteristics of KCNQ1-deficient and KCNQ1-mutant CMs. Results During high-throughput MEA analysis, the electric field potential and action potential durations in KCNQ1-deficient CMs were significantly longer than those in wild-type CMs. KCNQ1-deficient CMs also showed an irregular rhythm. Furthermore, KCNQ1-deficient and KCNQ1-mutant CMs showed different responses to different drug treatments, which reflected the differences in their pathogenic mechanisms. Conclusion We established a human CM model with KCNQ1 deficiency showing a prolonged QT interval and an irregular heart rhythm. Further, we used various drugs to treat KCNQ1-deficient and KCNQ1-mutant CMs, and the three models showed different responses to these drugs. These models can be used as important tools for studying the different pathogenic mechanisms of KCNQ1 mutation and the relationship between the genotype and phenotype of KCNQ1, thereby facilitating drug development. Supplementary Information The online version contains supplementary material available at 10.1186/s13287-022-02964-3.
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Affiliation(s)
- Yuanxiu Song
- Department of Cardiology, Peking University Third Hospital, 49 Huayuan North Road, Haidian District, Beijing, 100191, China
| | - Tianwei Guo
- Beijing Lab for Cardiovascular Precision Medicine, Anzhen Hospital, Capital Medical University, Beijing, 100029, China
| | - Youxu Jiang
- Department of Cardiology, The Second Affiliated Hospital of Zhengzhou University, Jingba Road, Zhengzhou, 450053, China
| | - Min Zhu
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Hongyue Wang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Wenjing Lu
- Shenzhen Key Laboratory of Cardiovascular Disease, Fuwai Hospital Chinese Academy of Medical Sciences, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, 518057, China
| | - Mengqi Jiang
- Department of Cell Biology, School of Basic Medical Sciences, Peking University Health Science Center, Beijing, 100191, China
| | - Man Qi
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Feng Lan
- Shenzhen Key Laboratory of Cardiovascular Disease, Fuwai Hospital Chinese Academy of Medical Sciences, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, 518057, China.
| | - Ming Cui
- Department of Cardiology, Peking University Third Hospital, 49 Huayuan North Road, Haidian District, Beijing, 100191, China.
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Rotvig C, Christensen AV, Juel K, Svendsen JH, Jørgensen MB, Rasmussen TB, Borregaard B, Thrysoee L, Thorup CB, Mols RE, Berg SK. The association between cardiac drug therapy and anxiety among cardiac patients: results from the national DenHeart survey. BMC Cardiovasc Disord 2022; 22:280. [PMID: 35725383 PMCID: PMC9210711 DOI: 10.1186/s12872-022-02724-4] [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: 04/06/2022] [Accepted: 06/08/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Neuropsychiatric side effects of cardiac drugs such as nervousness, mood swings and agitation may be misinterpreted as symptoms of anxiety. Anxiety in cardiac patients is highly prevalent and associated with poor outcomes, thus an accurate identification is essential. The objectives were to: (I) describe the possible neuropsychiatric side effects of common cardiac drug therapies, (II) describe the use of cardiac drug therapy in cardiac patients with self-reported symptoms of anxiety compared to those with no symptoms of anxiety, and (III) investigate the association between the use of cardiac drug therapy and self-reported symptoms of anxiety. METHODS DenHeart is a large national cross-sectional survey combined with national register data. Symptoms of anxiety were measured by the Hospital Anxiety and Depression Scale (HADS-A) on patients with ischemic heart disease, arrhythmia, heart failure and heart valve disease. Side effects were obtained from 'product summaries', and data on redeemed prescriptions obtained from the Danish National Prescription Registry. Multivariate logistic regression analyses explored the association between cardiac drug therapies and symptoms of anxiety (HADS-A ≥ 8). RESULTS Among 8998 respondents 2891 (32%) reported symptoms of anxiety (HADS-A ≥ 8). Neuropsychiatric side effects were reported from digoxin, antiarrhythmics, beta-blockers, ACE-inhibitors and angiotensin receptor antagonists. Statistically significant higher odds of reporting HADS ≥ 8 was found in users of diuretics, lipid-lowering agents, nitrates, antiarrhythmics and beta-blockers compared to patients with no prescription. CONCLUSION Some cardiac drugs were associated with self-reported symptoms of anxiety among patients with cardiac disease. Of these drugs neuropsychiatric side effects were only reported for antiarrhythmics and beta-blockers. Increased awareness about the possible adverse effects from these drugs are important.
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Affiliation(s)
- Camilla Rotvig
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
| | | | - Knud Juel
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Jesper Hastrup Svendsen
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Martin Balslev Jørgensen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Psychiatric Centre Copenhagen, and Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Trine Bernholdt Rasmussen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Cardiology, Herlev and Gentofte University Hospital, Hellerup, Denmark
| | - Britt Borregaard
- Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, Odense, Denmark.,Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Lars Thrysoee
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Charlotte Brun Thorup
- Department of Cardiology and Department of Cardiothoracic Surgery and Clinical Nursing Research Unit, Aalborg University Hospital, Aalborg, Denmark
| | - Rikke Elmose Mols
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Selina Kikkenborg Berg
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Bakkar S, Cappellani D, Forfori F, Di Salvo C, Catarsi S, Ambrosini CE, Miccoli P, Bogazzi F, Materazzi G, Papini P. Early surgery: a favorable prognosticator in amiodarone-induced thyrotoxicosis-a single-center experience with 53 cases. Updates Surg 2022; 74:1413-1418. [PMID: 35612729 DOI: 10.1007/s13304-022-01297-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 05/09/2022] [Indexed: 11/27/2022]
Abstract
Fewer than 100 cases of amiodarone-induced thyrotoxicosis (AIT) managed surgically have been reported worldwide. This study aims to assess the outcome of thyroidectomy under general anesthesia in a relatively large case series. A retrospective analysis of the clinical records of 53 patients who underwent thyroidectomy for AIT between 1995 and 2019 was conducted. There were 48 (90%) males and 5 females with an average age of 63.7 years. Type 1 and 2 AIT were present in 35 (66%) and 18 (34%) of patients, respectively. The mean preoperative ejection fraction (EF) was 45 ± 13%. Salvage surgery was performed in 6 (11%) patients due to decompensating heart failure and/or malignant arrhythmias. 35 (66%) patients underwent urgent surgery due to a predicted late response to medical therapy and/or the need to discontinue it. Elective surgery was performed in the remainder. A considerable improvement in mean EF occurred 12 months post-surgery (44% vs. 49%; p < 0.001). The overall survival rate following thyroidectomy was 96% at 12 months, and 83% at 5 years. No survival differences were observed based on systolic function. Cardiac-specific mortality was 11%, and these patients demonstrated a considerably shorter survival post-surgery compared to those who died of a non-cardiac cause (27 ± 18 vs. 77.5 ± 54 months; p < 0.05). Total thyroidectomy can be safely performed under general anesthesia despite severe cardiac disease. It considerably improves cardiac function and confers a survival advantage. Therefore, it should be considered early in the treatment plan of select cases.
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Affiliation(s)
- Sohail Bakkar
- Department of Surgery, Faculty of Medicine, Hashemite University, Zarqa, 13133, Jordan.
| | - Daniele Cappellani
- Department of Clinical and Experimental Medicine, University of Pisa, 56124, Pisa, Italy
| | - Francesco Forfori
- Department of Surgical, Medical, Molecular Pathology, and Critical Care, University of Pisa, 56124, Pisa, Italy
| | - Claudio Di Salvo
- Department of Surgical, Medical, Molecular Pathology, and Critical Care, University of Pisa, 56124, Pisa, Italy
| | - Sonia Catarsi
- Department of Surgical, Medical, Molecular Pathology, and Critical Care, University of Pisa, 56124, Pisa, Italy
| | - Carlo Enrico Ambrosini
- Department of Surgical, Medical, Molecular Pathology, and Critical Care, University of Pisa, 56124, Pisa, Italy
| | - Paolo Miccoli
- Department of Surgical, Medical, Molecular Pathology, and Critical Care, University of Pisa, 56124, Pisa, Italy
| | - Fausto Bogazzi
- Department of Clinical and Experimental Medicine, University of Pisa, 56124, Pisa, Italy
| | - Gabriele Materazzi
- Department of Surgical, Medical, Molecular Pathology, and Critical Care, University of Pisa, 56124, Pisa, Italy
| | - Piermarco Papini
- Department of Surgical, Medical, Molecular Pathology, and Critical Care, University of Pisa, 56124, Pisa, Italy
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10
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Di Cosmo C, De Marco G, Agretti P, Ferrarini E, Dimida A, Falcetta P, Benvenga S, Vitti P, Tonacchera M. Screening for drugs potentially interfering with MCT8-mediated T 3 transport in vitro identifies dexamethasone and some commonly used drugs as inhibitors of MCT8 activity. J Endocrinol Invest 2022; 45:803-814. [PMID: 34850364 DOI: 10.1007/s40618-021-01711-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 11/19/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Monocarboxylate transporter 8 (MCT8) is the first thyroid hormone transporter that has been linked to a human disease. Besides genetic alterations other factors might impair MCT8 activity. AIM This study aimed at investigating whether some common drugs having a structural similarity with TH and/or whose treatment is associated with thyroid function test abnormalities, or which behave as antagonists of TH action can inhibit MCT8-mediated T3 transport. METHODS [125I]T3 uptake and efflux were measured in COS-7 cells transiently transfected with hMCT8 before and after exposure to increasing concentrations of hydrocortisone, dexamethasone, prednisone, prednisolone, amiodarone, desethylamiodarone, dronedarone, buspirone, carbamazepine, valproic acid, and L-carnitine. The mode of inhibition was also determined. RESULTS Dexamethasone significantly inhibited T3 uptake at 10 μM; hydrocortisone reduced T3 uptake only at high concentrations, i.e. at 500 and 1000 μM; prednisone and prednisolone were devoid of inhibitory potential. Amiodarone caused a reduction of T3 uptake by MCT8 only at the highest concentrations used (44% at 50 μM and 68% at 100 μM), and this effect was weaker than that produced by desethylamiodarone and dronedarone; buspirone resulted a potent inhibitor, reducing T3 uptake at 0.1-10 μM. L-Carnitine inhibited T3 uptake only at 500 mM and 1 M. Kinetic experiments revealed a noncompetitive mode of inhibition for all compounds. All drugs inhibiting T3 uptake did not affect T3 release. CONCLUSION This study shows a novel effect of some common drugs, which is inhibition of T3 transport mediated by MCT8. Specifically, dexamethasone, buspirone, desethylamiodarone, and dronedarone behave as potent inhibitors of MCT8.
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Affiliation(s)
- C Di Cosmo
- Department of Clinical and Experimental Medicine, Endocrinology Unit, University of Pisa, via Paradisa 2, 56124, Pisa, Italy.
| | - G De Marco
- Department of Clinical and Experimental Medicine, Endocrinology Unit, University of Pisa, via Paradisa 2, 56124, Pisa, Italy
| | - P Agretti
- Laboratory of Chemistry and Endocrinology, University Hospital of Pisa, Pisa, Italy
| | - E Ferrarini
- Department of Clinical and Experimental Medicine, Endocrinology Unit, University of Pisa, via Paradisa 2, 56124, Pisa, Italy
| | - A Dimida
- Department of Clinical and Experimental Medicine, Endocrinology Unit, University of Pisa, via Paradisa 2, 56124, Pisa, Italy
| | - P Falcetta
- Department of Clinical and Experimental Medicine, Endocrinology Unit, University of Pisa, via Paradisa 2, 56124, Pisa, Italy
| | - S Benvenga
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - P Vitti
- Department of Clinical and Experimental Medicine, Endocrinology Unit, University of Pisa, via Paradisa 2, 56124, Pisa, Italy
| | - M Tonacchera
- Department of Clinical and Experimental Medicine, Endocrinology Unit, University of Pisa, via Paradisa 2, 56124, Pisa, Italy
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You HS, Yoon JH, Cho SB, Choi YD, Kim YH, Choi W, Kang HC, Choi SK. Amiodarone-Induced Multi-Systemic Toxicity Involving the Liver, Lungs, Thyroid, and Eyes: A Case Report. Front Cardiovasc Med 2022; 9:839441. [PMID: 35295268 PMCID: PMC8918574 DOI: 10.3389/fcvm.2022.839441] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 02/02/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectivesAmiodarone is widely used to treat arrhythmia. However, amiodarone is known for its severe toxicity to the liver, lungs, and thyroid. Amiodarone causes liver damage ranging from asymptomatic serum aminotransferase elevation to hepatic failure requiring liver transplantation. Although amiodarone toxicity has been reported, its simultaneous multi-organ toxicity is not well-known. Here, we introduce a novel case of multi-systemic amiodarone toxicity involving the liver, lungs, thyroid, and eyes.Case PresentationA 61-year-old woman visited the emergency room due to general weakness, nausea, visual disturbance, heat intolerance, and a non-productive cough. The patient had been using clopidogrel and amiodarone due to underlying atrial fibrillation. The total level of bilirubin was 0.71 mg/dL, aspartate aminotransferase was 358 U/L, alanine aminotransferase was 177 U/L, and prothrombin time was 27.1 s. Computed tomography showed diffuse increased liver intensity and scattered hyperattenuated nodular consolidations in both lungs. Transthoracic needle lung biopsy revealed fibrinoid interstitial inflammation with atypical change of type II pneumocytes and intra-alveolar foamy macrophages. In addition, the thyroid-stimulating hormone level was <0.008 μIU/mL, and free thyroxine was 4.67 ng/dL. The thyroid scan showed diffuse homogenous intake of technetium-99 m pertechnetate in both thyroid lobes. The ophthalmologic exam detected bilateral symmetrical corneal deposits in a vortex pattern. With these findings, we could diagnose amiodarone-induced hepatic, pulmonary, thyroid, and ophthalmologic toxicity. Liver function was restored after cessation of amiodarone, and thyroid function was normalized with methimazole administration. However, due to aggravated lung consolidations, systemic steroid treatment was administered, and improvement was seen 1 week after, at the follow-up exam. As her symptoms improved, she was discharged with a plan of steroid administration for 3 to 6 months.ConclusionsThis case implies the possibility of multi-systemic amiodarone toxicity. Thus, the toxicity of amiodarone to multiple organs must be monitored. Prompt cessation of the drug should be considered upon diagnosis.
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Affiliation(s)
- Hye-Su You
- Department of Gastroenterology and Hepatology, Chonnam National University Hospital and Medical School, Gwangju, South Korea
| | - Jae Hyun Yoon
- Department of Gastroenterology and Hepatology, Chonnam National University Hospital and Medical School, Gwangju, South Korea
- *Correspondence: Jae Hyun Yoon
| | - Sung Bum Cho
- Department of Gastroenterology and Hepatology, Hwasun Chonnam National University Hospital and Medical School, Hwasun, South Korea
| | - Yoo-Duk Choi
- Department of Pathology, Chonnam National University Hospital and Medical School, Gwangju, South Korea
| | - Yung Hui Kim
- Department of Ophthalmology, Chonnam National University Hospital and Medical School, Gwangju, South Korea
| | - Wonsuk Choi
- Department of Endocrinology, Hwasun Chonnam National University Hospital and Medical School, Hwasun, South Korea
| | - Ho-Cheol Kang
- Department of Endocrinology, Hwasun Chonnam National University Hospital and Medical School, Hwasun, South Korea
| | - Sung Kyu Choi
- Department of Gastroenterology and Hepatology, Chonnam National University Hospital and Medical School, Gwangju, South Korea
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12
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Lisco G, Giagulli VA, Iovino M, Zupo R, Guastamacchia E, De Pergola G, Iacoviello M, Triggiani V. Endocrine system dysfunction and chronic heart failure: a clinical perspective. Endocrine 2022; 75:360-376. [PMID: 34713389 PMCID: PMC8553109 DOI: 10.1007/s12020-021-02912-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 10/13/2021] [Indexed: 11/01/2022]
Abstract
Chronic heart failure (CHF) leads to an excess of urgent ambulatory visits, recurrent hospital admissions, morbidity, and mortality regardless of medical and non-medical management of the disease. This excess of risk may be attributable, at least in part, to comorbid conditions influencing the development and progression of CHF. In this perspective, the authors examined and described the most common endocrine disorders observed in patients with CHF, particularly in individuals with reduced ejection fraction, aiming to qualify the risks, quantify the epidemiological burden and discuss about the potential role of endocrine treatment. Thyroid dysfunction is commonly observed in patients with CHF, and sometimes it could be the consequence of certain medications (e.g., amiodarone). Male and female hypogonadism may also coexist in this clinical context, contributing to deteriorating the prognosis of these patients. Furthermore, growth hormone deficiency may affect the development of adult myocardium and predispose to CHF. Limited recommendation suggests to screen endocrine disorders in CHF patients, but it could be interesting to evaluate possible endocrine dysfunction in this setting, especially when a high suspicion coexists. Data referring to long-term safety and effectiveness of endocrine treatments in patients with CHF are limited, and their impact on several "hard" endpoints (such as hospital admission, all-cause, and cardiovascular mortality) are still poorly understood.
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Affiliation(s)
- Giuseppe Lisco
- Interdisciplinary Department of Medicine, Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, University of Bari "Aldo Moro", School of Medicine, Policlinico, Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - Vito Angelo Giagulli
- Interdisciplinary Department of Medicine, Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, University of Bari "Aldo Moro", School of Medicine, Policlinico, Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - Michele Iovino
- Interdisciplinary Department of Medicine, Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, University of Bari "Aldo Moro", School of Medicine, Policlinico, Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - Roberta Zupo
- National Institute of Gastroenterology, Saverio de Bellis, Research Hospital, Castellana Grotte, Bari, Italy
| | - Edoardo Guastamacchia
- Interdisciplinary Department of Medicine, Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, University of Bari "Aldo Moro", School of Medicine, Policlinico, Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - Giovanni De Pergola
- National Institute of Gastroenterology, Saverio de Bellis, Research Hospital, Castellana Grotte, Bari, Italy
- Clinical Nutrition Unit, Medical Oncology, Department of Internal Medicine and Clinical Oncology, University of Bari, School of Medicine, Policlinico, Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - Massimo Iacoviello
- Department of Medical and Surgical Sciences, Cardiology Department, University of Foggia, Foggia, Italy
| | - Vincenzo Triggiani
- Interdisciplinary Department of Medicine, Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, University of Bari "Aldo Moro", School of Medicine, Policlinico, Piazza Giulio Cesare 11, 70124, Bari, Italy.
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Alaie M, Tramutola A, Mukamal D. A Case Report on Methimazole-Induced Severe Hypothyroidism. Cureus 2022; 14:e21339. [PMID: 35186597 PMCID: PMC8849643 DOI: 10.7759/cureus.21339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2022] [Indexed: 11/05/2022] Open
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15
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Safronenko AV, Lepyavka SV, Demidov IA, Nazheva MI, Maklyakov YS. Optimization of premedication of patients with arterial hypertension and severe ventricular rhythm disturbances with Amiodarone-associated thyrotoxicosis. RESEARCH RESULTS IN PHARMACOLOGY 2021. [DOI: 10.3897/rrpharmacology.7.78137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction: The effectiveness of premedication of patients with arterial hypertension and severe ventricular rhythm disturbances against the background of Amiodarone-associated thyrotoxicosis, high anxiety and cyclothymiae disorders should be based on the pharmacological positions of the need to reduce the risk of dangerous adverse cardiovascular reactions.
Materials and methods: During the research, a clinical group of 114 patients with arterial hypertension, severe ventricular arrhythmias and Amiodarone-associated type I thyrotoxicosis was formed: four subgroups were identified. In Subgroup 1 (n=22), no premedication was given. In Subgroup 2 (n=32), premedication was given with Diazepam and magnesium sulfate in a prolonged mode. In Subgroup 3 (n=30), the patients received Diazepam the day before surgery. In Subgroup 4 (n=30), premedication was given with Midazolam. A dynamic assessment of the severity of anxiety, depression, sedation and daily monitoring of blood pressure and ECG were carried out.
Results and discussion: After surgery, in Subgroup 1, the level of anxiety and depression increased. In all other Subgroups, regardless of the type of premedication, the use of benzodiazepines was accompanied by a decrease in the level of anxiety after surgery. A decrease in pressure load and an increase in the stability of the parameters of systemic hemodynamics were registered in Subgroup 2 of patients, whereas in Subgroup 4 of patients, the pressure load increased while limiting the differences in blood pressure values during the day. After surgery, in Subgroup 2, cardiac rhythm disturbances were less common; in Subgroup 3, the structure of rhythmogenesis disturbances in the heart almost did not change, and in Subgroup 4, there was an unfavorable trend of an increase in the frequency of supraventricular, single and group ventricular extrasystoles.
Conclusion: The prolonged premedication with long-acting benzodiazepines and magnesium preparations in patients with arterial hypertension, ventricular rhythm disturbances against the background of Amiodarone-associated thyrotoxicosis reduces the level of anxiety, as well as the risk of developing cardiovascular complications and instability of systemic hemodynamics.
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16
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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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17
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Yamakawa H, Kato TS, Noh JY, Yuasa S, Kawamura A, Fukuda K, Aizawa Y. Thyroid Hormone Plays an Important Role in Cardiac Function: From Bench to Bedside. Front Physiol 2021; 12:606931. [PMID: 34733168 PMCID: PMC8558494 DOI: 10.3389/fphys.2021.606931] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 09/28/2021] [Indexed: 01/07/2023] Open
Abstract
Thyroid hormones (THs) are synthesized in the thyroid gland, and they circulate in the blood to regulate cells, tissues, and organs in the body. In particular, they exert several effects on the cardiovascular system. It is well known that THs raise the heart rate and cardiac contractility, improve the systolic and diastolic function of the heart, and decrease systemic vascular resistance. In the past 30 years, some researchers have studied the molecular pathways that mediate the role of TH in the cardiovascular system, to better understand its mechanisms of action. Two types of mechanisms, which are genomic and non-genomic pathways, underlie the effects of THs on cardiomyocytes. In this review, we summarize the current knowledge of the action of THs in the cardiac function, the clinical manifestation and parameters of their hemodynamics, and treatment principles for patients with hyperthyroid- or hypothyroid-associated heart disease. We also describe the cardiovascular drugs that induce thyroid dysfunction and explain the mechanism underlying the thyroid toxicity of amiodarone, which is considered the most effective antiarrhythmic agent. Finally, we discuss the recent reports on the involvement of thyroid hormones in the regulation of myocardial regeneration and metabolism in the adult heart.
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Affiliation(s)
- Hiroyuki Yamakawa
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
- Center for Preventive Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Tomoko S. Kato
- Department of Cardiology, International University of Health and Welfare Narita Hospital, Chiba, Japan
| | | | - Shinsuke Yuasa
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Akio Kawamura
- Department of Cardiology, International University of Health and Welfare Narita Hospital, Chiba, Japan
| | - Keiichi Fukuda
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Yoshiyasu Aizawa
- Department of Cardiology, International University of Health and Welfare Narita Hospital, Chiba, Japan
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18
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Brancatella A, Lupi I, Montanelli L, Ricci D, Viola N, Sgrò D, Antonangeli L, Sardella C, Brogioni S, Piaggi P, Molinaro E, Bianchi F, Aragona M, Antonuzzo A, Sbrana A, Lucchesi M, Chella A, Falcone A, Del Prato S, Elisei R, Marcocci C, Caturegli P, Santini F, Latrofa F. Management of Thyrotoxicosis Induced by PD1 or PD-L1 Blockade. J Endocr Soc 2021; 5:bvab093. [PMID: 34337277 PMCID: PMC8317632 DOI: 10.1210/jendso/bvab093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Indexed: 12/18/2022] Open
Abstract
Context Thyrotoxicosis is a common immune-related adverse event in patients treated with programmed cell death protein-1 (PD1) or programmed cell death protein ligand-1 (PD-L1) blockade. A detailed endocrinological assessment, including thyroid ultrasound and scintigraphy, is lacking, as are data on response to treatment and follow-up. Objective The aim of this study was to better characterize the thyrotoxicosis secondary to immune checkpoint inhibitors, gaining insights into pathogenesis and treatment. Methods We conducted a retrospective study of 20 consecutive patients who had normal thyroid function before starting immunotherapy and then experienced thyrotoxicosis on PD1 or PD-L1 blockade. Clinical assessment was combined with thyroid ultrasound, 99mtechnecium scintiscan, and longitudinal thyroid function tests. Results Five patients had normal or increased scintigraphic uptake (Sci+), no serum antibodies against the thyrotropin receptor, and remained hyperthyroid throughout follow-up. The other 15 patients had no scintigraphic uptake (Sci–) and experienced destructive thyrotoxicosis followed by hypothyroidism (N = 9) or euthyroidism (N = 6). Hypothyroidism was more readily seen in those with normal thyroid volume than in those with goiter (P = .04). Among Sci– individuals, a larger thyroid volume was associated with a longer time to remission (P < .05). Methimazole (MMI) was effective only in Sci+ individuals (P < .05). Conclusion Administration of PD1- or PD-L1–blocking antibodies may induce 2 different forms of thyrotoxicosis that appear similar in clinical severity at onset: a type 1 characterized by persistent hyperthyroidism that requires treatment with MMI, and a type 2, characterized by destructive and transient thyrotoxicosis that evolves to hypothyroidism or euthyroidism. Thyroid scintigraphy and ultrasound help in differentiating and managing these 2 forms of iatrogenic thyrotoxicosis.
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Affiliation(s)
| | - Isabella Lupi
- Endocrinology Unit, Azienda Ospedaliero-Universitaria Pisana, University Hospital of Pisa, Pisa 56124, Italy
| | - Lucia Montanelli
- Endocrinology Unit, Azienda Ospedaliero-Universitaria Pisana, University Hospital of Pisa, Pisa 56124, Italy
| | - Debora Ricci
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa 56126, Italy
| | - Nicola Viola
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa 56126, Italy
| | - Daniele Sgrò
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa 56126, Italy
| | - Lucia Antonangeli
- Endocrinology Unit, Azienda Ospedaliero-Universitaria Pisana, University Hospital of Pisa, Pisa 56124, Italy
| | - Chiara Sardella
- Endocrinology Unit, Azienda Ospedaliero-Universitaria Pisana, University Hospital of Pisa, Pisa 56124, Italy
| | - Sandra Brogioni
- Endocrinology Unit, Azienda Ospedaliero-Universitaria Pisana, University Hospital of Pisa, Pisa 56124, Italy
| | - Paolo Piaggi
- Department of Information Engineering, University of Pisa, Pisa 56126, Italy
| | - Eleonora Molinaro
- Endocrinology Unit, Azienda Ospedaliero-Universitaria Pisana, University Hospital of Pisa, Pisa 56124, Italy
| | - Francesca Bianchi
- Nuclear Medicine Unit, Azienda Ospedaliero-Unuversitaria Pisana, University Hospital of Pisa, Pisa 56124, Italy
| | - Michele Aragona
- Metabolic Diseases and Diabetes Unit, Azienda Ospedaliero-Universitaria Pisana, University Hospital of Pisa, Pisa 56124, Italy
| | - Andrea Antonuzzo
- Oncology Unit, Azienda Ospedaliero-Universitaria Pisana, University Hospital of Pisa, Pisa 56126, Italy
| | - Andrea Sbrana
- Oncology Unit, Azienda Ospedaliero-Universitaria Pisana and Department of Translational Research and New Technologies in Medicine and Surgery, University Hospital of Pisa, Pisa 56126, Italy
| | - Maurizio Lucchesi
- Pneumology Unit, Azienda Ospedaliero-Universitaria Pisana, University Hospital of Pisa, Pisa 56124, Italy
| | - Antonio Chella
- Pneumology Unit, Azienda Ospedaliero-Universitaria Pisana, University Hospital of Pisa, Pisa 56124, Italy
| | - Alfredo Falcone
- Oncology Unit, Azienda Ospedaliero-Univeritaria Pisana and Department of Translational Research and New Technologies in Medicine abd Surgery, University Hospital of Pisa, Pisa 56126, Italy
| | - Stefano Del Prato
- Metabolic Diseases and Diabetes Unit, Azienda Ospedaliero-Universitaria Pisana and Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa 56124, Italy
| | - Rossella Elisei
- Endocrinology Unit, Azienda Ospedaliero-Universitaria Pisana and Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa 56124, Italy
| | - Claudio Marcocci
- Endocrinology Unit, Azienda Ospedaliero-Universitaria Pisana and Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa 56124, Italy
| | - Patrizio Caturegli
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21205, USA
| | - Ferruccio Santini
- Endocrinology Unit, Azienda Ospedaliero-Universitaria Pisana and Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa 56124, Italy
| | - Francesco Latrofa
- Endocrinology Unit, Azienda Ospedaliero-Universitaria Pisana and Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa 56124, Italy
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Ibrahim Fouad G, R Mousa M. The protective potential of alpha lipoic acid on amiodarone-induced pulmonary fibrosis and hepatic injury in rats. Mol Cell Biochem 2021; 476:3433-3448. [PMID: 33973131 DOI: 10.1007/s11010-021-04173-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 04/28/2021] [Indexed: 12/13/2022]
Abstract
Amiodarone (AMD) is a widely used antiarrhythmic drug prescribed to treat cardiac tachyarrhythmias; however, AMD has been reported to provoke pulmonary fibrosis (PF) and hepatotoxicity. This study aimed to investigate the influence of alpha lipoic acid (ALA) on AMD-induced PF and hepatotoxicity in male Wistar rats. AMD administration resulted in elevated lung contents of hydroxyproline (Hyp), malondialdehyde (MDA), and increased serum levels of transforming growth factor beta-1 (TGF-β1), interferon-γ (IFN-γ), alanine amino transaminase (ALT), aspartate amino transaminase (AST), total cholesterol (TC), and glucose. On the other side, lung content of glutathione reduced (GSH) and serum levels of total anti-oxidant capacity (TAC) were significantly decreased. Histopathologically, AMD caused PF, produced a mild hepatic injury, and increased expression of alpha smooth muscle actin (α-SMA). Treatment with ALA produced a significant reversal of the oxidative stress, fibrosis, and inflammation parameters with reductions in α-SMA expressions, leading to amelioration of histopathological lesions. ALA might provide supportive therapy in AMD-receiving cardiovascular patients.
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Affiliation(s)
- Ghadha Ibrahim Fouad
- Department of Therapeutic Chemistry, National Research Centre, 33 El-Bohouth St., Dokki, Cairo, 12622, Egypt.
| | - Mohamed R Mousa
- Department of Pathology, Faculty of Veterinary Medicine, Cairo University, Giza, 12211, Egypt
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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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21
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Cappellani D, Urbani C, Manetti L, Martino E, Bartalena L, Bogazzi F. Effect of high-dose intravenous glucocorticoid therapy on serum thyroid hormone concentrations in type 2 amiodarone-induced thyrotoxicosis: an exploratory study. J Endocrinol Invest 2020; 43:1637-1643. [PMID: 32300976 DOI: 10.1007/s40618-020-01252-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 04/08/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE Type 2 amiodarone-induced thyrotoxicosis (AIT2) is a form of drug-induced destructive thyroiditis, usually treated with oral glucocorticoids (oGCs). Our objective was to investigate the short-term effects of intravenous glucocorticoids (ivGCs) on serum thyroid hormone concentrations in patients with AIT2. METHODS Exploratory study of three naive AIT2 patients treated with iv methylprednisolone (two pulses of 400 mg with no interpulse oGCs), followed by oGCs, matched 1:3 with AIT2 patients treated with oGCs alone. Changes in serum thyroid hormone concentrations were evaluated in the short-term period (24 h and 7 days) and after a cumulative dosage of 400 and 800 mg equivalents of methylprednisolone; in addition, healing time and duration of exposure to GCs were calculated. RESULTS During the first 24 h of treatment, serum FT4 concentrations increased in ivGCs patients, and decreased in oGCs patients (+ 3.3% vs - 10.7%, respectively, p = 0.025). After 7 days, serum FT4 and FT3 concentrations decreased significantly in both groups, with no statistical difference between them (p = 0.439 for FT4 and p = 0.071 for FT3), even though the cumulative GCs dose was higher in ivGCs than in oGCs patients (800 mg vs 280 mg, p = 0.008). Furthermore, the iv administration of single 400 mg pulses of methylprednisolone resulted in a less significant decrease in serum thyroid hormone concentrations when compared to equivalent GCs doses fractionated in several consecutive days (p = 0.021 for FT4 and p = 0.052 for FT3). There were no significant differences in the healing time (p = 0.239) and duration of exposure to GCs (p = 0.099). CONCLUSIONS High-dose ivGCs therapy does not offer advantages over standard oGCs therapy in the rapid, short-term control of AIT2.
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Affiliation(s)
- D Cappellani
- Department of Clinical and Experimental Medicine, Unit of Endocrinology, University of Pisa, Ospedale Cisanello, via Paradisa 2, 56124, Pisa, Italy
| | - C Urbani
- Department of Clinical and Experimental Medicine, Unit of Endocrinology, University of Pisa, Ospedale Cisanello, via Paradisa 2, 56124, Pisa, Italy
| | - L Manetti
- Department of Clinical and Experimental Medicine, Unit of Endocrinology, University of Pisa, Ospedale Cisanello, via Paradisa 2, 56124, Pisa, Italy
| | - E Martino
- Department of Clinical and Experimental Medicine, Unit of Endocrinology, University of Pisa, Ospedale Cisanello, via Paradisa 2, 56124, Pisa, Italy
| | - L Bartalena
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - F Bogazzi
- Department of Clinical and Experimental Medicine, Unit of Endocrinology, University of Pisa, Ospedale Cisanello, via Paradisa 2, 56124, Pisa, Italy.
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22
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Chua MWJ, Mok SF. Amiodarone Induced Thyrotoxicosis and Treatment Complications in a Man With Cyanotic Congenital Heart Disease: A Case Report. Front Cardiovasc Med 2020; 7:574391. [PMID: 33330642 PMCID: PMC7673448 DOI: 10.3389/fcvm.2020.574391] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 09/28/2020] [Indexed: 12/04/2022] Open
Abstract
Background and Case: Amiodarone induced thyrotoxicosis (AIT) is a potentially life-threatening condition that exists in two main subtypes – AIT Type 1 (AIT1) and AIT Type 2 (AIT2). AIT1 is a form of iodine-induced hyperthyroidism with increased thyroid hormone synthesis, while AIT2 is a form of destructive thyroiditis with increased release of pre-formed thyroid hormone. This case report describes a patient with cyanotic congenital heart disease, who developed AIT with severe biochemical thyrotoxicosis. Due to complications to corticosteroids and thionamides, second-line treatment with cholestyramine and lithium was given which eventually restored euthyroidism, averting the need for thyroidectomy and its associated risks. Due to the presence of both typical and unusual features, the final diagnosis of AIT2 could only be retrospectively elucidated after a prolonged clinical course. Conclusion: Corticosteroids are well-recognized to be the first-line treatment for AIT2. This case illustrates a rare phenomenon: successful treatment of AIT2 with lithium and cholestyramine. In patients who develop complications from first-line therapy, prompt treatment with alternative agents may successfully avert thyroidectomy and its associated risks.
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Affiliation(s)
- Marvin Wei Jie Chua
- Department of General Medicine, Sengkang General Hospital, Singapore, Singapore
| | - Shao Feng Mok
- Division of Endocrinology, Department of Medicine, National University Health System, Singapore, Singapore
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23
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Steinberg E, Fluksman A, Zemmour C, Tischenko K, Karsch-Bluman A, Brill-Karniely Y, Birsner AE, D'Amato RJ, Benny O. Low dose amiodarone reduces tumor growth and angiogenesis. Sci Rep 2020; 10:18034. [PMID: 33093573 PMCID: PMC7582908 DOI: 10.1038/s41598-020-75142-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 10/06/2020] [Indexed: 11/09/2022] Open
Abstract
Amiodarone is an anti-arrhythmic drug that was approved by the US Food and Drug Administration (FDA) in 1985. Pre-clinical studies suggest that Amiodarone induces cytotoxicity in several types of cancer cells, thus making it a potential candidate for use as an anti-cancer treatment. However, it is also known to cause a variety of severe side effects. We hypothesized that in addition to the cytotoxic effects observed in cancer cells Amiodarone also has an indirect effect on angiogensis, a key factor in the tumor microenvironment. In this study, we examined Amiodarone's effects on a murine tumor model comprised of U-87 MG glioblastoma multiforme (GBM) cells, known to form highly vascularized tumors. We performed several in vitro assays using tumor and endothelial cells, along with in vivo assays utilizing three murine models. Low dose Amiodarone markedly reduced the size of GBM xenograft tumors and displayed a strong anti-angiogenic effect, suggesting dual cancer fighting properties. Our findings lay the ground for further research of Amiodarone as a possible clinical agent that, used in safe doses, maintains its dual properties while averting the drug's harmful side effects.
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Affiliation(s)
- Eliana Steinberg
- The Institute for Drug Research, The School of Pharmacy, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Arnon Fluksman
- The Institute for Drug Research, The School of Pharmacy, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Chalom Zemmour
- The Institute for Drug Research, The School of Pharmacy, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Katerina Tischenko
- The Institute for Drug Research, The School of Pharmacy, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Adi Karsch-Bluman
- The Institute for Drug Research, The School of Pharmacy, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yifat Brill-Karniely
- The Institute for Drug Research, The School of Pharmacy, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Amy E Birsner
- Vascular Biology Program, Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Robert J D'Amato
- Vascular Biology Program, Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Ofra Benny
- The Institute for Drug Research, The School of Pharmacy, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel.
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24
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The Clinical Value and Variation of Antithyroid Antibodies during Pregnancy. DISEASE MARKERS 2020; 2020:8871951. [PMID: 33144894 PMCID: PMC7599418 DOI: 10.1155/2020/8871951] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 07/15/2020] [Accepted: 07/31/2020] [Indexed: 01/03/2023]
Abstract
Antithyroid antibodies, which include thyroid-stimulating hormone receptor antibodies (TRAbs), thyroid peroxidase antibodies (TPOAbs), and thyroid globulin antibodies (TgAbs), are widely known for their tight association with thyroid autoimmune diseases. The variation in all three kinds of antibodies also showed different trends during and after pregnancy (Weetman, 2010). This article reviewed the the physiological changes, while focusing on the variation of thyroid antibodies concentration in women during and after pregnancy, and adverse consequences related to their elevation. Since abnormal elevations of these antithyroid antibodies may lead to adverse outcomes in both mothers and fetuses, special attention must be paid to the titer of the antibodies during pregnancy. The molecular mechanisms of the variations in those antibodies have yet to be explained. The frequency and timing of thyroid antibody measurement, as well as different reference levels, also remain to be elucidated.
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25
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González A, Paz S, Rubio C, Gutiérrez ÁJ, Hardisson A. Human Exposure to Iodine from the Consumption of Edible Seaweeds. Biol Trace Elem Res 2020; 197:361-366. [PMID: 31820353 DOI: 10.1007/s12011-019-01996-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Accepted: 11/26/2019] [Indexed: 10/25/2022]
Abstract
The increasing consumption of wakame algae (Undaria pinnatifida) and kombu (Laminaria ochroleuca) because of their culinary appeal and beneficial properties means there is a need to study the composition of these new foods. Algae stand out for their high iodine content, this being an essential element whenever it is ingested at recommended levels but which, ingested in high quantities, can cause harmful effects to health such as hyperthyroidism and even goiter. The iodine content in 30 samples of algae from different geographical origins (Asia and Europe) has been determined by oxidation-reduction titration with sodium thiosulfate. European kombu algae (27.7 ± 5.4 mg/kg dry weight) have the highest mean average iodine concentrations. European algae have higher iodine content than Asian algae. Significant differences (p < 0.05) have been recorded among wakame algae according to geographical origin. The consumption of 4 g/day of European kombu algae means an intake of 111 μg/day of iodine, which is a value close to the RDI (recommended daily intake) set at 150 μg/day. It is necessary to monitor iodine levels in algae to avoid excessive intakes and harmful effects on health.
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Affiliation(s)
- Aitana González
- Department of Toxicology, Universidad de La Laguna, La Laguna, Tenerife, Canary Islands, Spain
| | - Soraya Paz
- Department of Toxicology, Universidad de La Laguna, La Laguna, Tenerife, Canary Islands, Spain.
| | - Carmen Rubio
- Department of Toxicology, Universidad de La Laguna, La Laguna, Tenerife, Canary Islands, Spain
| | - Ángel J Gutiérrez
- Department of Toxicology, Universidad de La Laguna, La Laguna, Tenerife, Canary Islands, Spain
| | - Arturo Hardisson
- Department of Toxicology, Universidad de La Laguna, La Laguna, Tenerife, Canary Islands, Spain
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26
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Eder S, Hermann C, Lamkowski A, Kinoshita M, Yamamoto T, Abend M, Shinomiya N, Port M, Rump A. A comparison of thyroidal protection by stable iodine or perchlorate in the case of acute or prolonged radioiodine exposure. Arch Toxicol 2020; 94:3231-3247. [PMID: 32656655 PMCID: PMC7415763 DOI: 10.1007/s00204-020-02809-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 06/15/2020] [Indexed: 12/14/2022]
Abstract
In the case of a nuclear power plant accident, repetitive/prolonged radioiodine release may occur. Radioiodine accumulates in the thyroid and by irradiation enhances the risk of cancer. Large doses of non-radioactive iodine may protect the thyroid by inhibiting radioiodine uptake into the gland (iodine blockade). Protection is based on a competition at the active carrier site in the cellular membrane and the Wolff-Chaikoff effect, the latter being, however, only transient (24-48 h). Perchlorate may alternatively provide protection by a carrier competition mechanism only. Perchlorate has, however, a stronger affinity to the carrier than iodide. Based on an established biokinetic-dosimetric model developed to study iodine blockade, and after its extension to describe perchlorate pharmacokinetics and the inhibition of iodine transport through the carrier, we computed the protective efficacies that can be achieved by stable iodine or perchlorate in the case of an acute or prolonged radioiodine exposure. In the case of acute radioiodine exposure, perchlorate is less potent than stable iodine considering its ED50. A dose of 100 mg stable iodine has roughly the same protective efficacy as 1000 mg perchlorate. For prolonged exposures, single doses of protective agents, whether stable iodine or perchlorate, offer substantially lower protection than after acute radioiodine exposure, and thus repetitive administrations seem necessary. In case of prolonged exposure, the higher affinity of perchlorate for the carrier in combination with the fading Wolff-Chaikoff effect of iodine confers perchlorate a higher protective efficacy compared to stable iodine. Taking into account the frequency and seriousness of adverse effects, iodine and perchlorate at equieffective dosages seem to be alternatives in case of short-term acute radioiodine exposure, whereas preference should be given to perchlorate in view of its higher protective efficacy in the case of longer lasting radioiodine exposures.
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Affiliation(s)
- Stefan Eder
- Bundeswehr Institute of Radiobiology, Neuherberg Str. 11, 80937, Munich, Germany
| | - Cornelius Hermann
- Bundeswehr Institute of Radiobiology, Neuherberg Str. 11, 80937, Munich, Germany
| | - Andreas Lamkowski
- Bundeswehr Institute of Radiobiology, Neuherberg Str. 11, 80937, Munich, Germany
| | - Manabu Kinoshita
- Japan Self Defense Forces National Defense Medical College Research Institute, Tokorozawa, Japan
| | - Tetsuo Yamamoto
- Japan Ground Self Defense Forces Military Medicine Research Unit and Ministry of Defense Clinic, Tokyo, Japan
| | - Michael Abend
- Bundeswehr Institute of Radiobiology, Neuherberg Str. 11, 80937, Munich, Germany
| | - Nariyoshi Shinomiya
- Japan Self Defense Forces National Defense Medical College Research Institute, Tokorozawa, Japan
| | - Matthias Port
- Bundeswehr Institute of Radiobiology, Neuherberg Str. 11, 80937, Munich, Germany
| | - Alexis Rump
- Bundeswehr Institute of Radiobiology, Neuherberg Str. 11, 80937, Munich, Germany.
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27
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The Use of 99mTc-Methoxy-isobutyl-isonitrile (sestaMIBI) Uptake on Scintigraphy ( 99m-STS) in Amiodarone-Induced Thyrotoxicosis: Case Series and Review of the Literature. Case Rep Endocrinol 2020; 2020:2493460. [PMID: 32832167 PMCID: PMC7421811 DOI: 10.1155/2020/2493460] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 07/03/2020] [Accepted: 07/11/2020] [Indexed: 11/18/2022] Open
Abstract
Amiodarone is a class III antiarrhythmic drug, used by cardiologists to treat arrhythmia including atrial fibrillation (A fib) and ventricular fibrillation. However, amiodarone is associated with endocrine dysfunction including both hypo- and hyperthyroidism. In the literature, two types of amiodarone-induced thyrotoxicosis (AIT) were described: AIT-1 and AIT-2. Mixed AIT also called AIT type 3 (AIT-3) has been described in the literature when the cases do not have a typical presentation. In order to differentiate different types of AIT, various clinical, biochemical, and radiological tools have been proposed. The use of 99mTc-methoxy-isobutyl-isonitrile (sestaMIBI) uptake on scintigraphy (99m-STS) has been suggested in the literature in only few studies (no large retrospective or prospective studies have been established in the United States). We present a case series describing 5 patients presenting to the University of Arizona with AIT where we used 99m-STS to assess in diagnosis and treatment of different types of AIT followed by a review of the literature.
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28
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Eilsberger F, Luster M, Feldkamp J. [Iodine-induced thyroid dysfunction]. Med Klin Intensivmed Notfmed 2020; 116:307-311. [PMID: 32583035 DOI: 10.1007/s00063-020-00699-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 04/03/2020] [Accepted: 04/26/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Iodine-induced thyroid dysfunctions are, despite their rare occurrence, important clinical syndromes. Their immediate recognition can avoid serious consequences. Important triggers can be iodine-containing contrast agents, amiodarone or iodine-containing disinfectants. Iodine-induced hypothyroidism and hyperthyroidism need to be distinguished, whereby the former is usually self-limiting. OBJECTIVES The aim of this article is to present current knowledge on the pathogenesis, therapy, and prophylaxis of iodine-induced thyroid dysfunction. MATERIALS AND METHODS We performed a literature search of current publications and linked them to daily clinical experience. RESULTS AND CONCLUSION In iodine-induced hyperthyroidism, antithyroid drugs and perchlorate are primarily used to decrease thyroid hormone synthesis and further iodine uptake into the thyroid. For the prophylaxis of x‑ray contrast agent-induced hyperthyroidism, perchlorate can be administered in high-risk settings in combination with antithyroid drugs, if possible starting one day before the iodine exposure.
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Affiliation(s)
- F Eilsberger
- Klinik für Nuklearmedizin, Universitätsklinikum Marburg, Baldingerstraße, 35043, Marburg, Deutschland.
| | - M Luster
- Klinik für Nuklearmedizin, Universitätsklinikum Marburg, Baldingerstraße, 35043, Marburg, Deutschland
| | - J Feldkamp
- Klinik für Allgemeine Innere Medizin, Endokrinologie, Diabetologie, Infektiologie, Klinikum Bielefeld Mitte, Bielefeld, Deutschland
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29
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Sudden onset of thyrotoxicosis induced by amiodarone mimicking low cardiac output syndrome in a patient with dilated cardiomyopathy. J Cardiol Cases 2020; 22:81-84. [PMID: 32774526 DOI: 10.1016/j.jccase.2020.05.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 04/11/2020] [Accepted: 04/27/2020] [Indexed: 11/23/2022] Open
Abstract
Amiodarone-induced thyrotoxicosis (AIT) is a complication of amiodarone therapy that can be difficult to diagnose and manage, especially in patients with dilated cardiomyopathy (DCM). We describe a 47-year-old female patient with DCM who experienced the sudden onset of type II AIT with symptoms mimicking low cardiac output syndrome, namely, general malaise and nausea. Early type II AIT was diagnosed, and effectively treated with prednisolone. <Learning objective: Amiodarone-induced thyrotoxicosis (AIT) is a complication of amiodarone therapy that can be difficult to diagnose and manage, especially in patients with dilated cardiomyopathy because of symptoms mimicking low cardiac output syndrome. We have to consider sudden onset of AIT in patients treated with amiodarone not to be late for appropriate management for it.>.
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30
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Katoh D, Yoshino H, Ikehara K, Kumashiro N, Uchino H, Tsuboi K, Hirose T. Successful Treatment of Amiodarone-induced Thyrotoxicosis Type 1 in Combination with Methimazole and Potassium Iodide in a Patient with Hashimoto's Thyroiditis. Intern Med 2020; 59:383-388. [PMID: 31554750 PMCID: PMC7028412 DOI: 10.2169/internalmedicine.2179-18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
A patient with underlying Hashimoto's thyroiditis developed amiodarone-induced thyrotoxicosis type 1 that was successfully treated using methimazole in combination with potassium iodide. A 35-year-old woman admitted for perinatal care of twin-to-twin transfusion syndrome was given amiodarone for 7 days for paroxysmal ventricular contraction following pulseless ventricular tachycardia 1 day after delivery. She developed thyrotoxicosis one month after the discontinuation of amiodarone therapy and was negative for thyroid-stimulating hormone receptor antibody. An increased peak velocity of the superior thyroid artery suggested amiodarone-induced thyrotoxicosis type 1. Her thyroid function recovered after combination therapy with methimazole and potassium iodide.
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Affiliation(s)
- Daisuke Katoh
- Division of Diabetes, Metabolism, and Endocrinology, Department of Medicine, Toho University Graduate School of Medicine, Japan
| | - Hiroshi Yoshino
- Division of Diabetes, Metabolism, and Endocrinology, Department of Medicine, Toho University Graduate School of Medicine, Japan
| | - Kayoko Ikehara
- Division of Diabetes, Metabolism, and Endocrinology, Department of Medicine, Toho University Graduate School of Medicine, Japan
| | - Naoki Kumashiro
- Division of Diabetes, Metabolism, and Endocrinology, Department of Medicine, Toho University Graduate School of Medicine, Japan
| | - Hiroshi Uchino
- Division of Diabetes, Metabolism, and Endocrinology, Department of Medicine, Toho University Graduate School of Medicine, Japan
| | - Kumiko Tsuboi
- Division of Diabetes, Metabolism, and Endocrinology, Department of Medicine, Toho University Graduate School of Medicine, Japan
| | - Takahisa Hirose
- Division of Diabetes, Metabolism, and Endocrinology, Department of Medicine, Toho University Graduate School of Medicine, Japan
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Omidi N, Khorgami M, Tajrishi FZ, Seyedhoseinpour A, Pasbakhsh P. The Role of Thyroid Diseases and their Medications in Cardiovascular Disorders: A Review of the Literature. Curr Cardiol Rev 2019; 16:103-116. [PMID: 31593532 PMCID: PMC7460701 DOI: 10.2174/1573403x15666191008111238] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 08/26/2019] [Accepted: 08/29/2019] [Indexed: 12/14/2022] Open
Abstract
The association between thyroid disease and cardiovascular manifestations is significant and undeniable. Previous studies have explained several aspects of the effects of thyroid hormone on the heart and cardiovascular system. Accordingly, both hyper and hypothyroidism can cause important alterations in cardiac rhythm, output and contractility as well as vascular resistance and blood pressure. Since treating the thyroid abnormality, especially in its initial stages, could lead to a significant improvement in most of its resultant cardiovascular disturbances, early suspicion and recognition of thyroid dysfunction, is necessary in patients with cardiovascular manifestations. In this in-depth review, we discuss the physiological roles as well as the effects of abnormal levels of thyroid hormones on the cardiovascular system. We also review the effects of the medications used for the treatment of hyper and hypothyroidism on cardiac function. In the end, we discuss the association between thyroid function and amiodarone, an effective and frequently-used antiarrhythmic drug, because of its well-known effects on the thyroid.
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Affiliation(s)
- Negar Omidi
- Cardiac Primary Prevention Research Center, Tehran Heart Center and Department of Cardiology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammadrafie Khorgami
- Rajaie Heart Center and Department of Pediatric Cardiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Farbod Z Tajrishi
- School of Medicine, Babol University of Medical Sciences, Babol, Iran
| | | | - Parichehr Pasbakhsh
- Department of Anatomical Sciences, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
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Trohman RG, Sharma PS, McAninch EA, Bianco AC. Amiodarone and thyroid physiology, pathophysiology, diagnosis and management. Trends Cardiovasc Med 2019; 29:285-295. [PMID: 30309693 PMCID: PMC6661016 DOI: 10.1016/j.tcm.2018.09.005] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [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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Markantes GK, Michalaki MA, Vagenakis GA, Lamari FN, Pitsi E, Eliopoulou M, Beratis NG, Markou KB. Plasma Beta-Glucuronidase Activity: A Novel Tool to Distinguish Type 1 from Type 2 Amiodarone-Induced Thyrotoxicosis? Eur Thyroid J 2019; 8:215-220. [PMID: 31602365 PMCID: PMC6738219 DOI: 10.1159/000500355] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 04/11/2019] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Amiodarone-induced thyrotoxicosis (AIT) is a common and deleterious side effect of amiodarone use. There are two types of AIT, characterized by distinct pathogenic mechanisms and, hence, different treatments. Discriminating between type 1 (AIT1) and type 2 (AIT2) AIT is often very challenging. Beta-glucuronidase (β-G) is a lysosomal enzyme released into the extracellular fluid during inflammation. OBJECTIVES To examine whether the determination of the plasma activity of β-G is useful in distinguishing AIT1 from AIT2. METHODS The study included 67 subjects: 9 with AIT1, 9 with AIT2, 14 with hyperthyroidism due to Grave's disease or toxic multinodular goiter, 14 with subacute thyroiditis, and 21 euthyroid controls. Thyroid function tests and plasma β-G activity were determined in all participants, while thyrotoxic patients also underwent thyroid ultrasound/scintigraphy and urine iodine excretion assessment. RESULTS Plasma β-G activity (expressed as mean ± SD in nmol 4-methylumbelliferone [4-MU]/mL plasma/h) in AIT2 was higher compared to AIT1 (2,263.6 ± 771 vs. 1,101.8 ± 201.9, p < 0.05) and similar to subacute thyroiditis (2,263.6 ± 771 vs. 2,083.2 ± 987.5, p = ns). β-G activity did not differ significantly between AIT1 and controls (1,101.8 ± 201.9 vs. 954.6 ± 248.6, p = ns). ROC curve analysis revealed that β-G activity had a high predictive value for destructive processes, namely AIT2 and subacute thyroiditis (AUC 0.846, 95% CI 0.748-0.943) and a cut-off value of 1,480.5 nmol 4-MU/mL plasma/h was able to discriminate between destructive and non-destructive thyroid conditions with 74% sensitivity and 82% specificity. CONCLUSION In our study, plasma β-G activity performed well in distinguishing AIT1 from AIT2. Further studies are warranted to establish its usefulness as a discriminator between the two AIT types.
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Affiliation(s)
- Georgios K. Markantes
- Division of Endocrinology – Department of Internal Medicine, University of Patras Medical School, Patras, Greece
| | - Marina A. Michalaki
- Division of Endocrinology – Department of Internal Medicine, University of Patras Medical School, Patras, Greece
| | - George A. Vagenakis
- Department of Pediatric Cardiology and Adult Congenital Heart Disease, Onassis Cardiac Surgery Center, Athens, Greece
| | - Fotini N. Lamari
- Laboratory of Pharmacognosy and Chemistry of Natural Products, Department of Pharmacy, University of Patras, Patras, Greece
| | - Efthymia Pitsi
- Laboratory of Pharmacognosy and Chemistry of Natural Products, Department of Pharmacy, University of Patras, Patras, Greece
| | | | - Nicholas G. Beratis
- Department of Pediatrics, University of Patras Medical School, Patras, Greece
| | - Kostas B. Markou
- Division of Endocrinology – Department of Internal Medicine, University of Patras Medical School, Patras, Greece
- *Kostas B. Markou, Department of Internal Medicine, Division of Endocrinology, University of Patras Medical School, GR–26500 Rio-Patras (Greece), E-Mail
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Thyroid Disorders in Homozygous β-Thalassemia: Current Knowledge, Emerging Issues and Open Problems. Mediterr J Hematol Infect Dis 2019; 11:e2019029. [PMID: 31205633 PMCID: PMC6548211 DOI: 10.4084/mjhid.2019.029] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Accepted: 03/08/2019] [Indexed: 12/19/2022] Open
Abstract
Changes in thyroid function and thyroid function tests occur in patients with β-thalassemia major (TM). The frequency of hypothyroidism in TM patients ranges from 4% to 29 % in different reports. The wide variation has been attributed to several factors such as patients’ genotype, age, ethnic heterogeneity, treatment protocols of transfusions and chelation, and varying compliance to treatment. Hypothyroidism is the result of primary gland failure or insufficient thyroid gland stimulation by the hypothalamus or pituitary gland. The main laboratory parameters of thyroid function are the assessments of serum thyroid-stimulating hor-mone (TSH) and serum free thyroxine (FT4). It is of primary importance to interpret these measurements within the context of the laboratory-specific normative range for each test. An elevated serum TSH level with a standard range of serum FT4 level is consistent with subclinical hypothyroidism. A low serum FT4 level with a low, or inappropriately normal, serum TSH level is consistent with secondary hypothyroidism. Doctors caring for TM patients most commonly encounter subjects with subclinical primary hypothyroidism in the second decade of life. Several aspects remain to be elucidated as the frequency of thyroid cancer and the possible existence of a relationship between thyroid dysfunction, on one hand, cardiovascular diseases, components of metabolic syndrome (insulin resistance) and hypercoagulable state, on the other hand. Further studies are needed to explain these emerging issues. Following a brief description of thyroid hormone regulation, production and actions, this article is conceptually divided into two parts; the first reports the spectrum of thyroid disease occurring in patients with TM, and the second part focuses on the emerging issues and the open problems in TM patients with thyroid disorders.
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Abstract
Amiodarone has multiple and complex electrophysiological effects that render it a very effective antiarrhythmic drug for the treatment of both, supraventricular and ventricular arrhythmias. Proarrhythmic effects of amiodarone in patients with structural heart disease are rare. However, extracardiac adverse effects occurring in association with amiodarone treatment are frequent and feared. These adverse effects have usually been related to total amiodarone exposure (i. e., dose and duration of treatment). Parallel to a more frequent use of lower amiodarone maintenance doses (100-200 mg/day), the incidence of severe unwanted extracardiac side effects has decreased. High-dose maintenance regiments (daily dose ≥300 mg) are usually obsolete. This paper discusses recommendations regarding the monitoring of cardiac and extracardiac side effects of amiodarone. They need to be regarded by physicians using amiodarone to ensure long-term safety of amiodarone therapy.
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Millington K, Charrow A, Smith J. Case Series: Minocycline-Associated Thyroiditis. Horm Res Paediatr 2019; 92:276-283. [PMID: 31533103 PMCID: PMC7078063 DOI: 10.1159/000502843] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 08/15/2019] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Minocycline, a member of the tetracycline class of antibiotics, has been associated with benign thyroid pigmentation but reports of thyroid dysfunction are sparse. METHODS Cases were selected via an inquiry of the electronic medical records for patients with thyroid dysfunction and the use of a tetracycline antibiotic. Non-autoimmune thyroiditis was defined as abnormally low or suppressed thyroid-stimulating hormone (TSH, <0.3 µIU/mL), elevated free thyroxine or total thyroxine, and undetectable antithyroid antibodies. RESULTS Nine cases of thyroiditis without autoimmunity were identified out of 423 reviewed patients. Cases of thyroiditis occurred in adolescents ages 14-17 years who had been taking minocycline for 6 months to 4 years. In all cases, minocycline was prescribed for the treatment of acne. Four of the 9 received treatment for thyrotoxicosis with a β-blocker (in 3 cases) and/or antithyroid drug (in 2 cases). Thyroiditis was symptomatic in all but one individual who presented with painless goiter. All thyroiditis was transient and resolved after a median of 4.5 months (range 2-5 months). In one case, thyroiditis was followed by transient hypothyroidism. DISCUSSION Minocycline is known to cause thyroid abnormalities, although it has not been definitively linked to thyroid dysfunction. Here, we report 9 cases of non-autoimmune thyroiditis in adolescents receiving minocycline for acne. We recommend that minocycline exposure be considered in the differential diagnosis for thyroiditis and that patients receiving minocycline be counseled regarding the risk of thyroid dysfunction.
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Affiliation(s)
- Kate Millington
- Division of Endocrinology, Boston Children's Hospital, Boston, Massachusetts, USA,
| | - Alexandra Charrow
- Department of Dermatology, Brigham and Women’s Hospital, Boston, Massachusetts, United States
| | - Jessica Smith
- Division of Endocrinology, Boston Children’s Hospital, Boston, Massachusetts, United States
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Kotwal A, Clark J, Lyden M, McKenzie T, Thompson G, Stan MN. Thyroidectomy for Amiodarone-Induced Thyrotoxicosis: Mayo Clinic Experience. J Endocr Soc 2018; 2:1226-1235. [PMID: 30370394 PMCID: PMC6198926 DOI: 10.1210/js.2018-00259] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Accepted: 08/30/2018] [Indexed: 11/19/2022] Open
Abstract
Context Amiodarone-induced thyrotoxicosis (AIT) is a difficult diagnostic and management challenge, especially during severe thyrotoxicosis accompanied by cardiovascular compromise. Objective To evaluate thyroidectomy for the management of AIT. Design Retrospective cohort study of adults with noncongenital heart disease with AIT after >3 months of amiodarone who underwent thyroidectomy from 1 November 2002 to 31 December 2016. Setting Referral center. Patients The group was comprised of 17 patients. Main Outcome Measures Thyroid function, left ventricular ejection fraction (LVEF), and surgical complications were the main outcome measures. Results Patients had median age of 60 years, 82.4% were male, and 47% had systolic heart failure. At diagnosis, median TSH was 0.005 mIU/L, median free T4 was 3.25 ng/dL, and total T3 was 198.5 ng/dL. We classified five patients as type 1 and type 2 and two patients as mixed; five patients remained undefined. The most common surgical indications were medically refractory disease, worsening cardiac status, and severe thyrotoxicosis requiring prompt resolution. Within 1 week post-thyroidectomy, median TSH was 0.565 mIU/L, and free T4 was 1.8 ng/dL. Median LVEF improved by 8% in patients with systolic heart failure. Seven patients had a complication within 30 days postsurgery (rehospitalization, n = 4; cervical hematoma, n = 2; recurrent arrhythmia, n = 2; symptomatic hypocalcemia, n = 1; death, n = 1). A larger thyroid gland was a risk factor for complications. Conclusions Thyroidectomy resulted in rapid resolution of thyrotoxicosis. Its complication rate was higher than for non-AIT indications but lower than previously reported in a similar population of high-risk surgical patients.
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Affiliation(s)
- Anupam Kotwal
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota
| | - Jennifer Clark
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Melanie Lyden
- Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | | | | | - Marius N Stan
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota
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Yamamoto JM, Katz PM, Bras JA, Shafer LA, Leung AA, Ravandi A, Cordova FJ. Amiodarone-induced thyrotoxicosis in heart failure with a reduced ejection fraction: A retrospective cohort study. Health Sci Rep 2018; 1:e36. [PMID: 30623071 PMCID: PMC6266468 DOI: 10.1002/hsr2.36] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 12/15/2017] [Accepted: 02/23/2018] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Amiodarone-induced thyrotoxicosis (AIT) is associated with significant morbidity and mortality. We aimed to describe AIT and its clinical outcomes in patients with heart failure with reduced ejection fraction (HFrEF). METHODS We performed a retrospective chart review at a heart failure center in Winnipeg, Canada. We screened 1059 consecutive patients seen over a 12-month period (August 2011 to July 2012) for AIT in patients with HFrEF. Using descriptive and Cox proportional hazard analyses, we explored the association between AIT and mortality. RESULTS A total of 110 patients with HFrEF who were exposed to amiodarone were included in the analysis. Of these, 13 (11.8%) were diagnosed with AIT. All AIT patients in our cohort were male. Amiodarone was discontinued in nearly half (46.2%) of patients with AIT. All patients were treated with antithyroid medications, and 5 patients (38.5%) also received prednisone. Euthyroidism was achieved in 2 patients (15.4%), hypothyroidism occurred in 6 patients (46.2%), and 5 patients remained thyrotoxic until death or time of chart review (38.5%). CONCLUSION Thyrotoxicosis is common in patients with HFrEF on amiodarone and is challenging to treat. Due to the sample size, while no association was found in mortality for patients with HFrEF with AIT, a real association could have been missed.
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Affiliation(s)
| | - Pamela M. Katz
- Department of Internal Medicine, Rady Faculty of Health Science, Max Rady College of MedicineUniversity of ManitobaWinnipegManitobaCanada
- Section of Endocrinology, Rady Faculty of Health Sciences, Max Rady College of MedicineUniversity of ManitobaWinnipegManitobaCanada
| | - James A.F. Bras
- Department of Internal Medicine, Rady Faculty of Health Science, Max Rady College of MedicineUniversity of ManitobaWinnipegManitobaCanada
| | - Leigh Anne Shafer
- Department of Internal Medicine, Rady Faculty of Health Science, Max Rady College of MedicineUniversity of ManitobaWinnipegManitobaCanada
| | - Alexander A. Leung
- Department of MedicineUniversity of CalgaryCalgaryAlbertaCanada
- Department of Community Health SciencesUniversity of CalgaryCalgaryAlbertaCanada
| | - Amir Ravandi
- Department of Internal Medicine, Rady Faculty of Health Science, Max Rady College of MedicineUniversity of ManitobaWinnipegManitobaCanada
- Section of Cardiology, Rady Faculty of Health Sciences, Max Rady College of MedicineUniversity of ManitobaWinnipegManitobaCanada
| | - Francisco J. Cordova
- Department of Internal Medicine, Rady Faculty of Health Science, Max Rady College of MedicineUniversity of ManitobaWinnipegManitobaCanada
- Section of Cardiology, Rady Faculty of Health Sciences, Max Rady College of MedicineUniversity of ManitobaWinnipegManitobaCanada
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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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Inoue K, Saito J, Kondo T, Miki K, Sugisawa C, Tsurutani Y, Hasegawa N, Kowase S, Kakuta Y, Omura M, Nishikawa T. Amiodarone-induced Thyrotoxicosis with Cardiopulmonary Arrest. Intern Med 2018; 57:59-63. [PMID: 29033440 PMCID: PMC5799058 DOI: 10.2169/internalmedicine.9177-17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We describe a case of amiodarone-induced thyrotoxicosis (AIT) with cardiopulmonary arrest (CPA) in a 49-year-old woman. The patient had been treated with amiodarone for non-sustained ventricular tachycardia. Two weeks prior to her admission, she developed thyrotoxicosis and prednisolone (PSL, 30 mg daily) was administered with the continuation of amiodarone. However, she was admitted to our hospital for CPA. We performed total thyroidectomy to control her thyrotoxicosis and the pathological findings were consistent with type 2 AIT. She gradually improved and was discharged on day 84. This case demonstrates the importance of considering immediate total thyroidectomy for patients with uncontrollable AIT.
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Affiliation(s)
- Kosuke Inoue
- Endocrinology and Diabetes Center, Yokohama Rosai Hospital, Japan
| | - Jun Saito
- Endocrinology and Diabetes Center, Yokohama Rosai Hospital, Japan
| | - Tetsuo Kondo
- Department of Human Pathology, University of Yamanashi Interdisciplinary Graduate School of Medicine and Engineering, Japan
| | - Kaoru Miki
- Departments of Endocrinology and Diabetes, JCHO Tokyo Yamate Medical Center, Japan
| | - Chiho Sugisawa
- Endocrinology and Diabetes Center, Yokohama Rosai Hospital, Japan
| | - Yuya Tsurutani
- Endocrinology and Diabetes Center, Yokohama Rosai Hospital, Japan
| | | | - Shinya Kowase
- Department of Cardiovascular Medicine, Yokohama Rosai Hospital, Japan
| | - Yukio Kakuta
- Department of Pathology, Yokohama Rosai Hospital, Japan
| | - Masao Omura
- Endocrinology and Diabetes Center, Yokohama Rosai Hospital, Japan
| | - Tetsuo Nishikawa
- Endocrinology and Diabetes Center, Yokohama Rosai Hospital, Japan
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Tonnelier A, de Filette J, De Becker A, Deweer S, Velkeniers B. Successful Pretreatment Using Plasma Exchange before Thyroidectomy in a Patient with Amiodarone-Induced Thyrotoxicosis. Eur Thyroid J 2017; 6:108-112. [PMID: 28589093 PMCID: PMC5422831 DOI: 10.1159/000453578] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 11/11/2016] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Amiodarone, used for the management of tachyarrhythmias, is associated with both hypothyroidism and thyrotoxicosis. Total thyroidectomy is an effective procedure for promptly reducing circulating thyroid hormone levels. It has been proposed in patients who have severe amiodarone-induced thyrotoxicosis (AIT) or are refractory to medical therapy, or when such therapy is contraindicated. Therapeutic plasma exchange (TPE) may be considered as a pretreatment for restoring a euthyroid state preoperatively, thereby reducing a patient's symptoms and the potential perioperative risk associated with thyrotoxicosis. CASE REPORT We describe the case of a 62-year-old man with type 2 AIT who presented with severe unremitting thyrotoxicosis after 8 weeks of medical therapy with glucocorticosteroids, thiamazole, and potassium perchlorate. Given the severity of his presentation, a total thyroidectomy was indicated. TPE was performed preoperatively and was successful in rapidly restoring euthyroidism. This dramatically improved the patient's symptoms which had been suggestive of ischemic heart disease. Subsequently, the patient underwent total thyroidectomy under general anesthesia without any major complications. CONCLUSION TPE is successful in rapidly restoring a clinical and biochemical euthyroid state, and may be used to decrease the perioperative risks associated with thyroidectomy in patients with life-threatening thyrotoxicosis or in cases refractory to medical treatment.
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Affiliation(s)
- Annelies Tonnelier
- Department of Endocrinology and General Internal Medicine, Brussels, Belgium
- *Annelies Tonnelier, Department of Endocrinology and General Internal Medicine, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB), Campus Jette, Laarbeeklaan 101, BE-1090 Brussels (Belgium), E-Mail
| | - Jeroen de Filette
- Department of Endocrinology and General Internal Medicine, Brussels, Belgium
| | - Ann De Becker
- Department of Hematology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Sophie Deweer
- Department of Department of Endocrinology and Diabetology, Algemeen Ziekenhuis Sint-Elisabeth Zottegem, Zottegem, Belgium
| | - Brigitte Velkeniers
- Department of Endocrinology and General Internal Medicine, Brussels, Belgium
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Wang M, Cai S, Ding W, Deng Y, Zhao Q. Efficacy and effects on cardiac function of radiofrequency catheter ablation vs. direct current cardioversion of persistent atrial fibrillation with left ventricular systolic dysfunction. PLoS One 2017; 12:e0174510. [PMID: 28350861 PMCID: PMC5370131 DOI: 10.1371/journal.pone.0174510] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 02/24/2017] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To evaluate the effect of catheter ablation vs. direct current synchronized cardioversion (DCC) in patients with persistent atrial fibrillation (AF) and left ventricular systolic dysfunction, and to define baseline features of patients that will get more benefit from ablation. METHODS From July 2013 to October 2014, 97 consecutive single-center patients with persistent AF and symptomatic heart failure (left ventricular ejection fraction (LVEF) <50%) underwent DCC followed by amiodarone (n = 40) or circumferential pulmonary vein isolation (PVI; n = 57) according to patient's preference were recruited in the study. Post-ablation recurrence was treated with atrial roof and mitral isthmus lines ablation with or without PVI based on restoration or not of pulmonary vein (PV) potential conduction. Study outcomes were 12-month rate of sustained sinus rhythm (SR) and cardiac function. Baseline characteristics were compared between patients with and without cardiac function improvement post ablation. RESULTS With similarly distributed characteristics at baseline, ablation (mean 1.8 procedures) relative to DCC yielded significantly higher level of 12-month SR maintenance rate (68.42% vs. 35%, P = 0.001); and better LVEF and New York Heart Association class. with significant effect for DCC only in maintained SR cases. Post ablation LVEF increased (>20% or to over 55%) in 31 (54.39%) patients with worse baseline cardiac function and ventricular rate control. CONCLUSIONS Catheter ablation relative to cardioversion of persistent AF with symptomatic heart failure yielded better 12-month SR maintenance and cardiac function. Compared with non-responders, patients with improved LVEF post-ablation had poorer ventricular rate control and cardiac function at baseline, suggesting a significant component of tachycardia-induced cardiomyopathy in this group.
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Affiliation(s)
- Maojing Wang
- Department of Cardiology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Shanglang Cai
- Department of Cardiology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Wei Ding
- Ophthalmology Department, Huangdao District People's Hospital, Qingdao, Shandong, China
| | - Yujie Deng
- Department of Cardiology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Qing Zhao
- Department of Cardiology, The Affiliated Hospital of Qingdao University, Qingdao, China
- * E-mail:
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Yamato M, Wada K, Fujimoto M, Hosomi K, Hayashi T, Oita A, Takada M. Association between N-desethylamiodarone/amiodarone ratio and amiodarone-induced thyroid dysfunction. Eur J Clin Pharmacol 2017; 73:289-296. [PMID: 28083650 DOI: 10.1007/s00228-017-2195-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 01/04/2017] [Indexed: 01/17/2023]
Abstract
PURPOSE We used a retrospective data mining approach to explore the association between serum amiodarone (AMD) and N-desethylamiodarone (DEA) concentrations and thyroid-related hormone levels. METHODS Laboratory data sets from January 2012 to April 2016 were extracted from the computerized hospital information system database at the National Cerebral and Cardiovascular Center (NCVC). Data sets that contained serum AMD and DEA concentrations and thyroid function tests, including thyroid-stimulating hormone (TSH), free thyroxine (FT4), and free triiodothyronine (FT3), were analyzed. RESULTS A total of 1831 clinical laboratory data sets from 330 patients were analyzed. Data sets were classified into five groups (euthyroidism, hyperthyroidism, subclinical hyperthyroidism, hypothyroidism, and subclinical hypothyroidism) based on the definition of thyroid function in our hospital. Most abnormal levels of thyroid hormones were observed within the therapeutic range of serum AMD and DEA concentrations. The mean DEA/AMD ratio in the hyperthyroidism group was significantly higher than that in the euthyroidism group (0.95 ± 0.42 vs. 0.87 ± 0.28, p = 0.0209), and the mean DEA/AMD ratio in the hypothyroidism group was significantly lower than that in the euthyroidism group (0.77 ± 0.26 vs. 0.87 ± 0.28, p = 0.0038). The suppressed TSH group (0.98 ± 0.41 vs. 0.87 ± 0.28, p < 0.001) and the elevated FT4 level group (0.90 ± 0.33 vs. 0.84 ± 0.27, p = 0.0037) showed significantly higher DEA/AMD ratios compared with normal level groups. The elevated TSH group showed a significantly lower DEA/AMD ratio compared with the normal group (0.81 ± 0.25 vs. 0.87 ± 0.28, p < 0.0001). CONCLUSIONS High and low DEA/AMD ratios were associated with AMD-induced hyperthyroidism and hypothyroidism, respectively. The DEA/AMD ratio may be a predictive marker for AMD-induced thyroid dysfunction.
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Affiliation(s)
- Mikie Yamato
- Division of Clinical Drug Informatics, School of Pharmacy, Kindai University, 3-4-1, Kowakae, Higashi-osaka, Osaka, 577-8502, Japan
- Department of Pharmacy, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kyoichi Wada
- Department of Pharmacy, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Mai Fujimoto
- Division of Clinical Drug Informatics, School of Pharmacy, Kindai University, 3-4-1, Kowakae, Higashi-osaka, Osaka, 577-8502, Japan
| | - Kouichi Hosomi
- Division of Clinical Drug Informatics, School of Pharmacy, Kindai University, 3-4-1, Kowakae, Higashi-osaka, Osaka, 577-8502, Japan
| | - Tomohiro Hayashi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Akira Oita
- Department of Pharmacy, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Mitsutaka Takada
- Division of Clinical Drug Informatics, School of Pharmacy, Kindai University, 3-4-1, Kowakae, Higashi-osaka, Osaka, 577-8502, Japan.
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Kinoshita S, Hayashi T, Wada K, Yamato M, Kuwahara T, Anzai T, Fujimoto M, Hosomi K, Takada M. Risk factors for amiodarone-induced thyroid dysfunction in Japan. J Arrhythm 2016; 32:474-480. [PMID: 27920832 PMCID: PMC5129120 DOI: 10.1016/j.joa.2016.03.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Revised: 03/15/2016] [Accepted: 03/24/2016] [Indexed: 11/24/2022] Open
Abstract
Background Amiodarone is associated with a number of significant adverse effects, including elevated transaminase levels, pulmonary fibrosis, arrhythmia, and thyroid dysfunction. Although thyroid dysfunction is considered to be a common and potentially serious adverse effect of amiodarone therapy, the exact pathogenesis remains unknown because of its complex manifestations. Therefore, the prevalence of, and risk factors for, amiodarone-induced thyroid dysfunction in Japanese patients were investigated in the present study. Methods A retrospective analysis of patients treated with amiodarone between January 2012 and December 2013 was performed. A total of 317 patients with euthyroidism, or subclinical hyperthyroidism or hypothyroidism, were enrolled in this study. Results After being treated with amiodarone, 30 (9.5%) and 60 patients (18.9%) developed amiodarone-induced hyperthyroidism and amiodarone-induced hypothyroidism, respectively. Ten (33.3%) patients with amiodarone-induced hyperthyroidism and 40 (66.6%) with amiodarone-induced hypothyroidism were diagnosed within two years of the initiation of amiodarone therapy. Dilated cardiomyopathy (DCM) [Adjusted odds ratio (OR) 3.30 (95% confidence interval (CI): 1.26–8.90)], and cardiac sarcoidosis [Adjusted OR 6.47 (95% CI: 1.60–25.77)] were identified as predictors of amiodarone-induced hyperthyroidism. The baseline free thyroxine (T4) level [Adjusted OR 0.13 (95% CI: 0.03–0.68)], and thyroid-stimulating hormone (TSH) level [Adjusted OR1.47 (95% CI: 1.26–1.74)] were identified as predictors of amiodarone-induced hypothyroidism. Conclusion DCM and cardiac sarcoidosis were identified as risk factors for amiodarone-induced hyperthyroidism. Risk factors for amiodarone-induced hypothyroidism included higher baseline TSH level and lower baseline free T4 level, suggesting that subclinical hypothyroidism may be a potential risk factor for the development of amiodarone-induced hypothyroidism.
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Affiliation(s)
- Sayoko Kinoshita
- Department of Pharmacy, National Cerebral and Cardiovascular Center, 5-7-1, Fujishiro-dai, Suita, Osaka 565-8565, Japan
| | - Tomohiro Hayashi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, 5-7-1, Fujishiro-dai, Suita, Osaka 565-8565, Japan
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-cho, Chuo-ku, Kobe, Hyogo 650-0017, Japan
| | - Kyoichi Wada
- Department of Pharmacy, National Cerebral and Cardiovascular Center, 5-7-1, Fujishiro-dai, Suita, Osaka 565-8565, Japan
- Corresponding author. Tel.: +81 6 6833 5012; fax:+81 6 6872 8074.
| | - Mikie Yamato
- Department of Pharmacy, National Cerebral and Cardiovascular Center, 5-7-1, Fujishiro-dai, Suita, Osaka 565-8565, Japan
- Division of Clinical Drug Informatics, School of Pharmacy, Kinki University, 3-4-1, Kowakae, Higashiosaka, Osaka 577-0818, Japan
| | - Takeshi Kuwahara
- Department of Pharmacy, National Cerebral and Cardiovascular Center, 5-7-1, Fujishiro-dai, Suita, Osaka 565-8565, Japan
| | - Toshihisa Anzai
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, 5-7-1, Fujishiro-dai, Suita, Osaka 565-8565, Japan
| | - Mai Fujimoto
- Division of Clinical Drug Informatics, School of Pharmacy, Kinki University, 3-4-1, Kowakae, Higashiosaka, Osaka 577-0818, Japan
| | - Kouichi Hosomi
- Division of Clinical Drug Informatics, School of Pharmacy, Kinki University, 3-4-1, Kowakae, Higashiosaka, Osaka 577-0818, Japan
| | - Mitsutaka Takada
- Division of Clinical Drug Informatics, School of Pharmacy, Kinki University, 3-4-1, Kowakae, Higashiosaka, Osaka 577-0818, Japan
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Tomisti L, Urbani C, Rossi G, Latrofa F, Sardella C, Manetti L, Lupi I, Marcocci C, Bartalena L, Curzio O, Martino E, Bogazzi F. The presence of anti-thyroglobulin (TgAb) and/or anti-thyroperoxidase antibodies (TPOAb) does not exclude the diagnosis of type 2 amiodarone-induced thyrotoxicosis. J Endocrinol Invest 2016; 39:585-91. [PMID: 26759156 DOI: 10.1007/s40618-015-0426-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 12/21/2015] [Indexed: 11/29/2022]
Abstract
PURPOSE It is widely accepted that type 2 amiodarone-induced thyrotoxicosis (AIT) generally occurs in patients with a normal thyroid gland without signs of thyroid autoimmunity. However, it is currently unknown if the presence of anti-thyroglobulin (TgAb) and/or anti-thyroperoxidase antibodies (TPOAb) in AIT patients without other signs of an underlying thyroid disease may impair the response to glucocorticoid therapy. METHODS We performed a pilot retrospective cohort study with matched-subject design and an equivalence hypothesis, comparing the response to glucocorticoid therapy between 20 AIT patients with a normal thyroid gland, low radioiodine uptake, undetectable TSH receptor antibodies and positive TgAb and/or TPOAb (Ab+ group), and 40 patients with the same features and absent thyroid antibodies (Ab- group). RESULTS The mean cure time was 54 ± 68 days in the Ab+ group and 55 ± 49 days in the Ab- group (p = 0.63). The equivalence test revealed an equivalent cure rate after 60, 90 and 180 days (p = 0.67, 0.88 and 0.278, respectively). The occurrence of permanent hypothyroidism was higher in the Ab+ group than in the Ab- group (26.3 vs 5.13 %, p = 0.032). CONCLUSIONS The presence of TgAb and/or TPOAb does not affect the response to glucocorticoid therapy, suggesting that the patients with features of destructive form of AIT should be considered as having a type 2 AIT irrespective of the presence of TGAb or TPOAb. These patients have a higher risk of developing hypothyroidism after the resolution of thyrotoxicosis and should be monitored accordingly.
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Affiliation(s)
- L Tomisti
- Endocrinology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Ospedale Cisanello, Via Paradisa, 2, 56124, Pisa, Italy
| | - C Urbani
- Endocrinology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Ospedale Cisanello, Via Paradisa, 2, 56124, Pisa, Italy
| | - G Rossi
- Unit of Epidemiology and Biostatistics, Institute of Clinical Physiology, National Research Council, 56184, Pisa, Italy
| | - F Latrofa
- Endocrinology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Ospedale Cisanello, Via Paradisa, 2, 56124, Pisa, Italy
| | - C Sardella
- Endocrinology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Ospedale Cisanello, Via Paradisa, 2, 56124, Pisa, Italy
| | - L Manetti
- Endocrinology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Ospedale Cisanello, Via Paradisa, 2, 56124, Pisa, Italy
| | - I Lupi
- Endocrinology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Ospedale Cisanello, Via Paradisa, 2, 56124, Pisa, Italy
| | - C Marcocci
- Endocrinology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Ospedale Cisanello, Via Paradisa, 2, 56124, Pisa, Italy
| | - L Bartalena
- Endocrine Unit, Department of Clinical and Experimental Medicine, University of Insubria, 21100, Varese, Italy
| | - O Curzio
- Unit of Epidemiology and Biostatistics, Institute of Clinical Physiology, National Research Council, 56184, Pisa, Italy
| | - E Martino
- Endocrinology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Ospedale Cisanello, Via Paradisa, 2, 56124, Pisa, Italy
| | - F Bogazzi
- Endocrinology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Ospedale Cisanello, Via Paradisa, 2, 56124, Pisa, Italy.
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Czarnywojtek A, Płazińska MT, Zgorzalewicz-Stachowiak M, Woliński K, Stangierski A, Miechowicz I, Waligórska-Stachura J, Gut P, Królicki L, Zioncheck M, Ruchała M. Dysfunction of the thyroid gland during amiodarone therapy: a study of 297 cases. Ther Clin Risk Manag 2016; 12:505-13. [PMID: 27110118 PMCID: PMC4831589 DOI: 10.2147/tcrm.s96606] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
AIM This study aims to explore and compare the efficacy of radioiodine treatment (RIT) in hyperthyroid and euthyroid patients who have been treated with amiodarone (AM) in the past or are currently undergoing AM treatment. Clinical observation of a group of patients with amiodarone-induced hypothyroidism during a 12-month follow-up period was used for comparison. DESIGN This was a observational, two-centered study. Patients were assessed at baseline and at 2 months, 6 months, 8 months, and 12 months after RIT. PATIENTS Group A: At baseline (61 males [M] and 17 females [F], mean age 50±19 years), there were 78 euthyroid patients with cardiac arrhythmias, who were treated with AM and developed amiodarone-induced thyrotoxicosis, and currently require retreatment with AM. Group B: Hyperthyroid patients (92 M and 26 F, mean age 72±11.8 years) after AM therapy in the past. Group C: Hyperthyroid patients (66 M and 13 F, mean age 63.9±13.2 years) currently treated by AM. Group D: Hypothyroid patients (6 M and 16 F, mean age 61.4±10.4 years) after AM therapy. The patients from Groups A, B, and C were retreated with AM after ~3-6 weeks of RIT. RESULTS In Group A, after 12 months of RIT therapy, recurrent thyrotoxicosis was observed in six (7.7%) cases, and persistent hypothyroidism was diagnosed in 42 (53.8%) cases. In Group B, hyperthyroidism occurring during treatment with AM was found in 40 (33.9%) patients, and permanent hypothyroidism was observed in eleven (12.5%) cases. After annual follow-up in Group C, nine (11.4%) patients were diagnosed with hypothyroidism, while 27 (34.1%) patients were diagnosed with hyperthyroidism. In Group D, all patients had permanent hypothyroidism and when the concentration of serum thyroid-stimulating hormone was >10 µIU/mL, l-thyroxine was applied. CONCLUSION Our study showed that radioiodine administration is advisable in certain circumstances, even in euthyroid patients. It allows for continuation of further long-term AM treatment. Additionally, RIT allows for the reintroduction of AM therapy that was previously terminated. Hence, it can help control life-threatening tachyarrhythmias and decrease episodes of thyrotoxicosis.
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Affiliation(s)
- Agata Czarnywojtek
- Department of Endocrinology, Metabolism and Internal Medicine, Poznan, Poland; Department of Pharmacology, Poznan University of Medical Sciences, Poznan, Poland
| | | | | | - Kosma Woliński
- Department of Endocrinology, Metabolism and Internal Medicine, Poznan, Poland
| | - Adam Stangierski
- Department of Endocrinology, Metabolism and Internal Medicine, Poznan, Poland
| | | | | | - Paweł Gut
- Department of Endocrinology, Metabolism and Internal Medicine, Poznan, Poland
| | - Leszek Królicki
- Nuclear Medicine Department, Medical University of Warsaw, Warsaw, Poznan, Poland
| | | | - Marek Ruchała
- Department of Endocrinology, Metabolism and Internal Medicine, Poznan, Poland
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A Case of Type 2 Amiodarone-Induced Thyrotoxicosis That Underwent Total Thyroidectomy under High-Dose Steroid Administration. Case Rep Endocrinol 2015; 2015:416145. [PMID: 25664188 PMCID: PMC4309302 DOI: 10.1155/2015/416145] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Accepted: 12/15/2014] [Indexed: 11/30/2022] Open
Abstract
Amiodarone is used commonly and effectively in the treatment of arrhythmia; however, it may cause thyrotoxicosis categorized into two types: iodine-induced hyperthyroidism (type 1 amiodarone-induced thyrotoxicosis (AIT)) and destructive thyroiditis (type 2 AIT). We experienced a case of type 2 AIT, in which high-dose steroid was administered intravenously, and we finally decided to perform total thyroidectomy, resulting in a complete cure of the AIT. Even though steroid had been administered to the patient (maximum 80 mg of prednisolone), the operation was performed safely and no acute adrenal crisis as steroid withdrawal syndrome was found after the operation. Few cases of type 2 AIT that underwent total thyroidectomy with high-dose steroid administration have been reported. The current case suggests that total thyroidectomy should be taken into consideration for patients with AIT who cannot be controlled by medical treatment and even in those under high-dose steroid administration.
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Amiodarone-induced thyrotoxic thyroiditis: a diagnostic and therapeutic challenge. Case Rep Med 2014; 2014:231651. [PMID: 25477968 PMCID: PMC4244946 DOI: 10.1155/2014/231651] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 10/23/2014] [Indexed: 01/15/2023] Open
Abstract
Amiodarone is an iodine-based, potent antiarrhythmic drug bearing a structural resemblance to thyroxine (T4). It is known to produce thyroid abnormalities ranging from abnormal thyroid function testing to overt hypothyroidism or hyperthyroidism. These adverse effects may occur in patients with or without preexisting thyroid disease. Amiodarone-induced thyrotoxicosis (AIT) is a clinically recognized condition commonly due to iodine-induced excessive synthesis of thyroid, also known as type 1 AIT. In rare instances, AIT is caused by amiodarone-induced inflammation of thyroid tissue, resulting in release of preformed thyroid hormones and a hyperthyroid state, known as type 2 AIT. Distinguishing between the two states is important, as both conditions have different treatment implications; however, a mixed presentation is not uncommon, posing diagnostic and treatment challenges. We describe a case of a patient with amiodarone-induced type 2 hyperthyroidism and review the current literature on the best practices for diagnostic and treatment approaches.
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Khan A, Puttanna A, Raskauskiene D. Amiodarone-induced thyrotoxicosis: type 1 or type 2? BMJ Case Rep 2014; 2014:bcr-2014-204485. [PMID: 25349184 DOI: 10.1136/bcr-2014-204485] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 69-year-old man presented with a 6-week history of shortness of breath on exertion, unintentional weight loss, altered bowel habits and lethargy. He was diagnosed with atrial fibrillation 2 years previously and started on amiodarone and warfarin. He subsequently reverted to sinus rhythm and his medication was stopped 1 year prior to presentation. He denied history of thyroid dysfunction. On examination, he had a small firm goitre of grade I. His skin was warm and sweaty. Thyroid function tests showed him to be thyrotoxic. He was started on carbimazole 20 mg; however, he further became significantly thyrotoxic. Given the severity of his presentation and lack of any clinical or biochemical improvement, oral prednisolone 30 mg once daily was coadministered. His symptoms subsequently resolved and he became euthyroid. The prednisolone was tapered down and stopped while the carbimazole was incrementally reduced to 10 mg daily.
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Affiliation(s)
- Ahsan Khan
- Walsall Hospitals Healthcare NHS Trust, Walsall, UK
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50
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Kim HL, Seo JB, Chung WY, Kim SH, Kim MA, Zo JH. The incidence and predictors of overall adverse effects caused by low dose amiodarone in real-world clinical practice. Korean J Intern Med 2014; 29:588-96. [PMID: 25228834 PMCID: PMC4164722 DOI: 10.3904/kjim.2014.29.5.588] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Revised: 12/03/2013] [Accepted: 04/07/2014] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND/AIMS Most current knowledge regarding amiodarone toxicity derives from clinical trials. This study was performed to investigate the incidence and risk factors of overall adverse effects of amiodarone in real-world practice using a large sample size. METHODS Between January 1, 2000 and March 10, 2012, a total of 930 consecutive patients who had been treated with amiodarone for arrhythmia were reviewed retrospectively. An amiodarone-associated adverse event was considered in cases of discontinuation or drug dose reduction due to an unexpected clinical response. RESULTS The mean daily dose of amiodarone was 227 ± 126 mg, and the mean duration was 490 ± 812 days. During the mean follow-up duration of 982 ± 1,137 days, a total of 154 patients (16.6%) experienced adverse effects related to amiodarone, the most common being bradycardia or conduction disturbance (9.5%). Major organ toxicities in the thyroid (2.5%), liver (2.2%), eyes (0.6%), and lungs (0.3%) were rare. All patients recovered fully without complications after amiodarone discontinuation or dose reduction. The only independent predictor of adverse effects was the duration of amiodarone treatment (odds ratio, 1.21; 95% confidence interval, 1.03 to 1.41; p = 0.016, per year). CONCLUSIONS Low-dose amiodarone is well tolerated in a real-world clinical population. Further studies with a prospective design are needed to confirm this finding.
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Affiliation(s)
- Hack-Lyoung Kim
- Division of Cardiology, Department of Internal Medicine, Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Jae-Bin Seo
- Division of Cardiology, Department of Internal Medicine, Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Woo-Young Chung
- Division of Cardiology, Department of Internal Medicine, Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Sang-Hyun Kim
- Division of Cardiology, Department of Internal Medicine, Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Myung-A Kim
- Division of Cardiology, Department of Internal Medicine, Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Joo-Hee Zo
- Division of Cardiology, Department of Internal Medicine, Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
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