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Effect of high-dose intravenous glucocorticoid therapy on serum thyroid hormone concentrations in type 2 amiodarone-induced thyrotoxicosis: an exploratory study

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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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Funding

This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.

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Authors and Affiliations

  1. Department of Clinical and Experimental Medicine, Unit of Endocrinology, University of Pisa, Ospedale Cisanello, via Paradisa 2, 56124, Pisa, Italy

    D. Cappellani, C. Urbani, L. Manetti, E. Martino & F. Bogazzi

  2. Department of Medicine and Surgery, University of Insubria, Varese, Italy

    L. Bartalena

Authors
  1. D. Cappellani
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  2. C. Urbani
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  3. L. Manetti
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  4. E. Martino
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  5. L. Bartalena
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  6. F. Bogazzi
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Corresponding author

Correspondence to F. Bogazzi.

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The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported.

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The study was approved by the Review Board of the Department of Clinical and Experimental Medicine of the University of Pisa.

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All the patients involved gave their written informed consent for collection of clinical data in anonymous form in a database and its usage for research purposes.

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Cappellani, D., Urbani, C., Manetti, L. et al. Effect of high-dose intravenous glucocorticoid therapy on serum thyroid hormone concentrations in type 2 amiodarone-induced thyrotoxicosis: an exploratory study. J Endocrinol Invest 43, 1637–1643 (2020). https://doi.org/10.1007/s40618-020-01252-2

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  • DOI: https://doi.org/10.1007/s40618-020-01252-2

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