The Characteristics of Amiodarone-induced Thyrotoxicosis in a Moderate Iodine Deficit Area

Open access

Abstract

Introduction: Amiodarone (AMI), a class III anti-arrhythmic drug, is associated with a number of side effects, including thyroid dysfunction (both hypo- and hyperthyroidism), which is due to amiodarone's high iodine content and its direct toxic effect on the thyroid. Objective: To evaluate the incidence of Amiodarone induced thyrotoxicosis (AIT) (type, rate of occurrence) and to identify the risk factors involved in its occurrence. Material and method: We examined patients treated with amiodarone, between January 2002 and December 2011, who presented to our Department of Endocrinology Târgu Mures for thyroid dysfunctions. Results: The retrospective study included 87 patients with thyroid dysfunctions; 58 (66.7%) patients had AIT and 29 (33.3%) had Amiodarone induced hypothyroidism (AIH). In the AIT group: 35 were women (60.3%), 23 were men (39.7%); the average age was 61.60 ± 12.39 years. Risk factors identified for the AIT group were male gender (RR = OR = 3.8; Chi-squer = 5.7, p = 0.004) and pre-existing thyroid abnormalities (RR = 2.5, Chi-square = 4.1, p = 0.005). The thyroid dysfunction occurrence was heterogeneous (0.2-183 months). The patients with previous thyroid abnormalities developed earlier thyroid dysfunction compared to those with an apparently normal thyroid gland (22.25 ± 4.14 months versus 32.09 ± 7.69 months, p = 0.02, T test). Conclusion: In the context of the specific iodine geoclimatic intake and the area of origin, amiodarone - induced thyroid dysfunction spectrum is dominated by thyrotoxicosis. Screening and monitoring of thyroid function for patiens under chronic amiodarone treatment is necessary

If the inline PDF is not rendering correctly, you can download the PDF file here.

  • 1. Fuks AG Vaisman M Buescu. Thyroid dysfunction and cardiological management in patients receiving amiodarone. Arquivos Brasileiros de Cardiologia. 2004;82(6):528-532.

  • 2. Siddoway LA. Amiodarone: guidelines for use and monitoring. American family physician. 2003;68(11):2189-96.

  • 3. Podrid PJ. Amiodarone reevaluation of an old drug. Ann. Intern. Med. 1995;122:689-700.

  • 4. Beddows S Page S Taylor A et al. Cytotoxic effects of amiodarone and desethylamiodarone on human thyrocytes. Biochem. Pharmacol. 1989;38:4397-4403.

  • 5. Basaria S Cooper D. Amiodarone and the thyroid. Am. J. Med. 2005;118:706-714.

  • 6. Padmanabhan H. Amiodarone and thyroid disfunction. South Med. J. A. 2010;103(9):922-930.

  • 7. Trip M Wiersinga W Plomp T. Incidence predictability and pathogenesis of amiodarone - induced thyrotoxicosis and hypothyroidism. Am. J. Med. 1991;91:507-511.

  • 8. Hofman A Nawara C Ofl uoglu S et al. Incidence and predictability of amiodaroneinduced thyrotoxicosis and hypothyroidism. Wien Klin Wochenschr. 2008;120(15-16):493-8.

  • 9. Martino E Aghini-Lombardi F Mariotti S et al. Amiodarone: a common source of iodine-induced thyrotoxicosis. Horm Res. 1987;26:158.

  • 10. Martino E Bartalena L Bogazzi F et al. The effects of amiodarone on the thyroid. Endocr. Rev. 2001;22:240-254.

  • 11. Bogazzi F Martino E Dell Unto E et al. Thyroid color fl ow doppler sonography and radioiodine uptake in 55 consecutive patients with amiodarone-induced tyrotoxicosis. J Endocrinol Invest. 2003;26(7):635-640.

  • 12. Bogazzi F Bartalena L Tomisi L et al. Glucocorticoid response in amiodarone-induced thyrotoxicosis resulting from destructive tyroiditis is predicted by thyroid volume and serum free thyroid hormone concentrations. J Clin Endocrinol Metab. 2007;92:556-562.

  • 13. Piga M Serra A Boi F et al. Amiodarone- induced thyrotoxicosis. A review. Minerva Endocrinol. 2008;33(3):213-228.

  • 14. Goldschlager N Epstein AE Naccarelli GV et al. A practical guide for clinicians who treat patients with amiodarone. Heart Rhythm. 2007;4(9):1250-1259.

  • 15. Franklyn JA. Amiodarone and thyroid hormone action. Clin. Endocinol. 1985;22:257.

  • 16. Gopalan M. Thyroid dysfunction induced by amiodarone therapy. Updated: Jul 2 2009. Workup http://emedicine.medscape.com/article/129033-workup#a0723.

  • 17. Sidhu J Jenkins D. Men are at increased risk of amiodarone-induced thyrotoxicosis in the UK. QJM. 2003;12:949-950.

  • 18. Aleksic Z Aleksic A. Incidence of amiodarone-induced thyroid disfunction and predictive factors for theier occurrence. Med Pregl. 2011;64(11-12): 533-538.

  • 19. Liang YL Huang SM Peng SL et al. Amiodarone-induced thyrotoxicosis in a patient with autonomously functioning nodular goiter. Ann Pharmacother. 2009;43(1):134-8.

  • 20. Tomisti L Dell’Unto E Brogioni S et al. Amiodarone induced thyrotoxicosis in patients with multinodular goiter: type 1 or type 2 AIT? Endocr Abst. 2010;22:765.

  • 21. Davis AB Orlander PR. Goiter Toxic Nodular. Updated: Apr 26 2010. Available from: http://emedicine.medscape.com/article/120497-overview.

  • 22. Bogazzi F Bartalena L Dell’Unto E et al. Proportion of type 1 and type 2 Amiodarone-induced thyrotoxicosis has changed over a 27-year period in Italy. Clin Endocrinol. 2007;67:533-537.

  • 23. Zosin I Balas M. Amiodarone induced thyroid disfunction in an iodine replete area: epidemiological and clinical data. Polish Jurnal Endoc. 2012;63(1):2-9.

  • 24. Binz K Burger A Vallotton MB. Amiodarone and thyroid function: clinical implications. Schweiz Med Wochenschr. 1998;128:1051-1058.

  • 25. Fiorini A. Monitoring thyroid function status in elderly patients on amiodarone. Malta Med J. 2006;18-24.

  • 26. Kun I Szántó Z Balázs J et al. Detection of Iodine Defi ciency Disorders (Goiter and Hypothyroidism) in School-Children Living in Endemic Mountainous Regions After the Implementation of Universal Salt Iodization. Hot Topics in Endocrine and Endocrine-Related Diseases Dr. Monica Fedele (Ed.) ISBN: 978-953-51-1080-4 InTech DOI: 10.5772/54188.

  • 27. Simescu M Dumitriu L Kun I et al. Urinary Iodine Levels in Schoolchildren and Pregnant Women After the Legislative Changes in the Salt Iodization. Acta Endocrinologica New series. 2006;2(1):33-44.

  • 28. Toma A Sava M Delia C et al. Universal Salt Iodization Effects on Endemic Goiter in Arges County Romania. Acta Endocrinologica (Bucharest) New series. 2005;1(2):167-180.

Search
Journal information
Metrics
All Time Past Year Past 30 Days
Abstract Views 0 0 0
Full Text Views 174 115 3
PDF Downloads 84 70 3