Pediatric Cardiology

, Volume 39, Issue 8, pp 1707–1716 | Cite as

Diagnosis and Clinical Course of Three Adolescents with Amiodarone-Induced Hyperthyroidism

  • Julia GesingEmail author
  • Julia Hoppmann
  • Roman Gebauer
  • Roland Pfäffle
  • Astrid Bertsche
  • Wieland Kiess
Case Report


Amiodarone-induced hyperthyroidism is a known side effect of amiodarone treatment. In the pediatric population, long-term amiodarone treatment is rarely indicated because of its severe side effects including thyroid function impairment. Treatment is therefore restricted to therapy-resistant arrhythmias. In the literature, scarce data are available on the management and therapy of amiodarone-induced thyroid dysfunction at a young age. We present three adolescent patients developing amiodarone-induced thyrotoxicosis in the months after amiodarone therapy. A latency period for thyroid dysfunction has been described in adulthood but was not previously reported in pediatric patients. The gap between amiodarone treatment and the development of symptoms and the diagnosis of hyperthyroidism was between 3 and 10 months. In two patients, hyperthyroidism was transient and resolved without treatment. These two patients, one boy and on girl, were almost asymptomatic. In contrast, in one male patient overt and severe hyperthyroidism developed. We began treatment with thiamazole without benefit. Control of hyperthyroidism was achieved under prednisone treatment, which was continued for 9 months. Clinical evaluation proved an amiodarone-induced destructive thyroiditis in this patient. Amiodarone-induced thyroid dysfunction is frequent also in pediatric patients with long-term amiodarone treatment. Patients and clinicians should be aware of the impact of amiodarone on thyroid function during and also in the months and maybe years after treatment. Careful follow-up is needed, as symptoms might be associated with the underlying cardiac disease in these patients. Amiodarone-induced thyrotoxicosis often resolves without treatment but can be challenging in some cases.


Amiodarone Hyperthyroidism Thyroid Arrhythmias Adolescents 


Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interests.

Ethical Approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed Consent

Informed consent was obtained from the three patients presented in the case series.


  1. 1.
    Brugada J, Blom N, Sarquella-Brugada G, Blomstrom-Lundqvist C, Deanfield J, JJanousek J, Abrams D, Bauersfeld U, Brugada R, Drago F, de Groot N, Happonen JM, Hebe J, Yen Ho S, Marijon E, Paul T, Pfammatter JP, Rosenthal E (2013) Pharmacological and non-pharmacological therapy for arrhythmias in the pediatric population: EHRA and AEPC Arrhythmia Working group joint consensus statement. Europace 15:1337–1382. CrossRefPubMedGoogle Scholar
  2. 2.
    Harjai KJ, Licata AA (1996) Amiodarone induced hyperthyroidism: a case series and brief review of literature. Pacing Clin Electrophysiol 19(11 Pt 1):1548–1554CrossRefGoogle Scholar
  3. 3.
    Chiovato L, Martino E, Tonacchera M, Santini F, Lapi P, Mammoli C, Braverman LE, Pinchera A (1994) Studies on the in vitro cytotoxic effect of amiodarone. Endocrinology 134(5):2277–2282CrossRefGoogle Scholar
  4. 4.
    Bogazzi F, Bartalena L, Martin E (2010) Approach to the patient with amiodarone-induced thyrotoxicosis. J Clin Endocrinol Metab 95:2529–2535CrossRefGoogle Scholar
  5. 5.
    Tanda ML, Piantanida E, Lai A, Liparulo L, Sassi L, Bogazzi F, Wiersinga WM, Braverman LE, Martino E, Bartalena L (2008) Diagnosis and management of amiodarone-induced thyrotoxicosis: similarities and differences between North American and European thyroidologists. Clin Endocrinol 69(5):812–818. CrossRefGoogle Scholar
  6. 6.
    Coumel PL, Fidelle J (1980) Amiodarone in the treatment of cardiac arrhythmias in children: one hundred thirty-five cases. Am Heart J 100:1063–1069CrossRefGoogle Scholar
  7. 7.
    Garson A Jr, Gillette PC, McVey P, Hesslein PS, Porter CJ, Angell LK, Kaldis LC, Hittner HM (1984) Amiodarone treatment of critical arrhythmias in children and young adults. J Am Coll Cardiol 4(4):749–755CrossRefGoogle Scholar
  8. 8.
    Bucknall CA, Keeton BR, Curry PV, Tynan MJ, Sutherland GR, Holt DW (1986) Intravenous and oral amiodarone for arrhythmias in children. Br Heart J 56(3):278–284CrossRefGoogle Scholar
  9. 9.
    Costigan DC, Holland FJ, Daneman D, Hesslein PS, Vogel M, Ellis G (1986) Amiodarone therapy effects on childhood thyroid function. Pediatrics 77(5):703–708PubMedGoogle Scholar
  10. 10.
    Ardura J, Hermoso F, Bermejo J (1988) Effect on growth of children with cardiac dysrhythmias treated with amiodarone. Pediatr Cardiol 9(1):33–36CrossRefGoogle Scholar
  11. 11.
    Guccione P, Paul T, Garson A Jr (1990) Long-term follow-up of amiodarone therapy in the young: continued efficacy, unimpaired growth, moderate side effects. J Am Coll Cardiol 15(5):1118–1124CrossRefGoogle Scholar
  12. 12.
    Bosser G, Marçon F, Lethor JP, Worms AM (1995) Long-term efficacy and tolerability of amiodarone in children. Arch Mal Coeur Vaiss 88(5):731–736PubMedGoogle Scholar
  13. 13.
    Celiker A, Koçak G, Lenk MK, Alehan D, Ozme S (1997) Short- and intermediate-term efficacy of amiodarone in infants and children with cardiac arrhythmia. Turk J Pediatr 39(2):219–225PubMedGoogle Scholar
  14. 14.
    Drago F, Mazza A, Guccione P, Mafrici A, Di Liso G, Ragonese P (1998) Amiodarone used alone or in combination with propranolol: a very effective therapy for tachyarrhythmias in infants and children. Pediatr Cardiol 19(6):445–449CrossRefGoogle Scholar
  15. 15.
    Dilber E, Mutlu M, Dilber B, Aslan Y, Gedik Y, Celiker A (2010) Intravenous amiodarone used alone or in combination with digoxin for life-threatening supraventricular tachyarrhythmia in neonates and small infants. Pediatr Emerg Care 26(2):82–84. CrossRefPubMedGoogle Scholar
  16. 16.
    Akin A, Karagöz T, Aykan HH, Özer S, Alehan D, Özkutlu S (2013) The efficacy of amiodarone-propranolol combination for the management of childhood arrhythmias. Pacing Clin Electrophysiol 36(6):727–731. CrossRefPubMedGoogle Scholar
  17. 17.
    Paech C, Wagner F, Suchowerskyj P, Weidenbach M (2016) The blue child-amiodarone-induced blue-gray skin syndrome and pulmonary mass in a child. Clin Case Rep 4(3):276–278CrossRefGoogle Scholar
  18. 18.
    Goldschlager N, Epstein AE, Naccarelli GV, Olshansky B, Singh B, Collard HR, Murphy E, Practice Guidelines Sub-Committee, North American Society of Pacing and Electrophysiology (2007) A practical guide for clinicians who treat patients with amiodarone: 2007. Heart Rhythm 4(9):1250–1259CrossRefGoogle Scholar
  19. 19.
    Moffett BS, Valdes SO, Kim JJ (2013) Amiodarone monitoring practices in pediatric hospitals in the United States. Pediatr Cardiol 34(8):1762–1766. CrossRefPubMedGoogle Scholar
  20. 20.
    Benjamens S, Dullaart RPF, Sluiter WJ, Rienstra M, van Gelder IC, Links TP (2017) The clinical value of regular thyroid function tests during amiodarone treatment. Eur J Endocrinol 177(1):9–14. CrossRefPubMedGoogle Scholar
  21. 21.
    Hacihamdioğlu B, Berberoğlu M, Siklar Z, Savaş Erdeve S, Oçal G, Tutar E, Atalay S (2010) Amiodarone-induced thyrotoxicosis in children and adolescents is a possible outcome in patients with low iodine intake. J Pediatr Endocrinol Metab 23(4):363–368CrossRefGoogle Scholar
  22. 22.
    Bogazzi F, Martino E, Dell’Unto E, Brogioni S, Cosci C, Aghini-Lombardi F, Ceccarelli C, Pinchera A, Bartalena L, Braverman LE (2003) Thyroid color flow doppler sonography and radioiodine uptake in 55 consecutive patients with amiodarone-induced thyrotoxicosis. J Endocrinol Invest 26(7):635–640CrossRefGoogle Scholar
  23. 23.
    Wang J, Zhang R (2017) Evaluation of 99mTc-MIBI in thyroid gland imaging for the diagnosis and classification of amiodarone-induced thyrotoxicosis. Br J Radiol 20:20160836. CrossRefGoogle Scholar
  24. 24.
    Theilade P, Hansen JM, Skovsted L, Faber J, Kirkegård C, Friis T, Siersbaek-Nielsen K (1977) Propranolol influences serum T3 and reverse T3 in hyperthyroidism. Lancet 2(8033):363CrossRefGoogle Scholar
  25. 25.
    Wilkins MR, Franklyn JA, Woods KL, Kendall MJ (1985) Effect of propranolol on thyroid homeostasis of healthy volunteers. Postgrad Med J 61(715):391–394CrossRefGoogle Scholar
  26. 26.
    Kayser L, Perrild H, Feldt-Rasmussen U, Hegedüs L, Skovsted L, Hansen JE (1991) The thyroid function and size in healthy man during 3 weeks treatment with beta-adrenoceptor-antagonists. Horm Metab Res 23(1):35–37CrossRefGoogle Scholar
  27. 27.
    Nicoloff JT, Fisher DA, Appleman MD Jr (1970) The role of glucocorticoids in the regulation of thyroid function in man. J Clin Invest 49(10):1922–1929CrossRefGoogle Scholar
  28. 28.
    Bartalena L, Bogazzi F, Chiovato L, Hubalewska-Dydejczyk A, Links TP, Vanderpump M (2018) 2018 European Thyroid Association (ETA) guidelines for the management of amiodarone-associated thyroid dysfunction. Eur Thyroid J 7(2):55–66. CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Trip MD, Wiersinga W, Plomp TA (1991) Incidence, predictability, and pathogenesis of amiodarone-induced thyrotoxicosis and hypothyroidism. Am J Med 91(5):507–511CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Hospital for Children and AdolescentsUniversity LeipzigLeipzigGermany
  2. 2.Department for Pediatric Cardiology, Leipzig Heart CenterUniversity of LeipzigLeipzigGermany

Personalised recommendations