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Rapid effectiveness of prednisone and thionamides combined therapy in severe amiodarone iodine-induced thyrotoxicosis. Comparison of two groups of patients with apparently normal thyroid glands

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Abstract

Treatment of amiodarone iodine-induced thyrotoxicosis is often unsuccessful. Nevertheless, severe forms require a rapidly efficient therapy. Twelve patients with severe amiodarone iodine-induced thyrotoxicosis, as demonstrated on clinical and biological findings, were studied. After amiodarone withdrawal, 6 patients (group A) were treated with thionamides alone (Carbimazole 60 mg daily and benzylthiouracile 1.5 g daily), and 6 patients (group B) received in addition to the same antithyroid drugs prednisone, 0.50 to 1.25 mg/kg/ day for 40 days; in group A, T4 levels did not change over the study period of 40 days; T3 levels decreased only after 30 days; clinical status did not improve. In group B: T3 and T4 levels decreased dramatically at 10 days of treatment, to values significantly lower than in group A; clinical improvement occurred mainly in patients treated with high doses of prednisone; elevated thyroglobulin levels diminished rapidly. Improvement was maintained after cessation of prednisone. The rapid effect of prednisone suggests an impairement of proteolysis of thyroglobulin possibly due to a lysosomal action.

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References

  1. Vastesaeger M., Gillot P., Rasson G. Etude clinique d’une nouvelle médication anti-angoreuse. Acta Cardiol. (Brux.) 22: 483, 1967.

    Google Scholar 

  2. Rosenbaum M.B., Chiale P.A., Halpern M.S. Clinical efficacy of amiodarone as an antiarrythmic agent. Am. J. Cardiol. 38: 934, 1976.

    Article  PubMed  CAS  Google Scholar 

  3. Heger J.J., Prytowosky E.N., Jackman W.M., Naccarelli G.V., Warfel K.A., Rinkenberger R.L., Zipes D.P. Amiodarone. Clinical efficacy and electrophysiology during long-term therapy for recurrent ventricular tachycardia or ventricular fibrillation. N. Engl. J. Med. 305: 539, 1981.

    Article  PubMed  CAS  Google Scholar 

  4. Singh B.N. Amiodarone: historical development and pharmacological profile. Am. Heart J. 106: 788, 1983

    Article  PubMed  CAS  Google Scholar 

  5. Burger A., Dinichert D., Nicod P., Jenny M., Lemarchand-Beraud T., Valloton M.B. Effect of amiodarone on serum triiodothyronine, reverse triiodothyronine, thyroxin and thyrotropin. A drug influencing peripheral metabolism of thyroid hormones. J. Clin. Invest. 58: 255, 1976.

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  6. Aanderud S., Sundsfjord J., Aarbakke J. Amiodarone inhibits the conversion of thyroxine to triodothyronine in isolated rat hepatocytes. Endocrinology 115: 1605, 1984.

    Article  PubMed  CAS  Google Scholar 

  7. Lambert M.J., Burger A.G, Galeazzi R.L., Engler D. Are selective increases in serum thyroxine (T4) due to iodinated inhibitors of T4monodeiodination indicative of hyperthyroidism? J. Clin. Endocrinol. Metab. 55: 1058, 1982.

    Article  PubMed  CAS  Google Scholar 

  8. Kannan R., Ookhtens M., Chopra I.J., Singh B.N. Effects of chronic administration of amiodarone on kinetics of metabolism of iodothyronines. Endocrinology 11: 1710, 1984.

    Article  Google Scholar 

  9. Rotmensch H.H., Beihassen B., Ferguson R.K. Amiodarone — benefits and risks in perspective. Am. Heart J. 104: 1117, 1982.

    Article  PubMed  CAS  Google Scholar 

  10. Harris L., Mc Kenna W.J., Rowland E., Holt D.W., Storey G.C.A., Krikler D.M. Side effects of long term amiodarone therapy. Circulation 67: 45, 1983.

    Article  PubMed  CAS  Google Scholar 

  11. Amico J.A., Richardson V., Alpert B., Klein I. Clinical and chemical assessment of thyroid function during therapy with amiodarone. Arch. Intern. Med. 144: 487, 1984.

    Article  PubMed  CAS  Google Scholar 

  12. Strauch G., Timsit J., Burger A, Orgiazzi J. Les hyperthyroidies induites par I’amiodarone. Presse Méd. 15: 113, 1986.

    PubMed  CAS  Google Scholar 

  13. Gammage M.D., Franklyn J.A. Amiodarone and the thyroid. Q.J. Med. 62: 83, 1987.

    PubMed  CAS  Google Scholar 

  14. Fradkin J.E., Woolf J. Iodine-induced thyrotoxicosis. Medicine 62: 1, 1983.

    PubMed  CAS  Google Scholar 

  15. Leger A.F., Massin J.P., Laurent M.F., Vincens M., Auriol M., Helal O.B., Chomette G., Savoie J.C. Iodine-induced thyrotoxicosis: analysis of eighty-five consecutive cases. Eur. J. Clin. Invest. 14: 449, 1984.

    Article  PubMed  CAS  Google Scholar 

  16. Martino E., Safran M., Aghini-Lombardi F., Rajatanavin R., Lenziardi M., Fay M., Pacchiarotti A., Aronin N., Macchia E., Haffajee C., Odoguardi L., Love J., Bigalli A., Bashieri L., Pinchera A., Braverman L. Environmental iodine intake and thyroid dysfunction during chronic amiodarone therapy. Ann. Intern. Med. 101: 28,1984.

    Article  PubMed  CAS  Google Scholar 

  17. Jonckeer M.H. Amiodarone therapy and hyperthyroidism in Europe. Arch. Intern. Med. 144: 2429, 1984.

    Article  Google Scholar 

  18. Savoie J.C., Massin J.P., Thomopoulos P., Leger F. Iodine-induced thyrotoxicosis in apparently normal thyroid glands. J. Clin. Endocrinol. Metab. 41: 685, 1975.

    Article  PubMed  CAS  Google Scholar 

  19. Bronstein V., Coignard A., Gautier D., Duret J.C., Droniou J. Thyrotoxicose sévère et surcharge iodée. A propos d’un cas d’évolution mortelle. Presse Méd. 11: 2226, 1982.

    CAS  Google Scholar 

  20. Winpfheimer C., Staubli M., Schädelin J., Studer H. Prednisone in amiodarone-induced thyrotoxicosis. Br. Med, J. 284: 1835, 1982.

    Article  Google Scholar 

  21. Simon C., Schlienger J.L., Cherfan J., Roul G., Vignon F., Chabrier G., Imler M. Efficacité de la dexaméthasone dans le traitment de l’hyperthyroidie à I’amiodarone. Press Méd. 13: 2767, 1984.

    CAS  Google Scholar 

  22. Martino E., Aghini-Lombardi F., Mariotti S., Lenziardi M., Baschieri L., Braverman L.E., Pinchera A. Treatment of amiodarone associated thyrotoxicosis by simultaneous administration of potassium Perchlorate and methimazole. J. Endocrinol. Invest. 9: 201, 1986.

    Article  PubMed  CAS  Google Scholar 

  23. Ardiet C., Bornet H., Favret H., Claustrat B., Peyrin J.O., Mayer M., Lahneche B. A radioimmunoassay for serum thyroglobulin: results in normal subjects and thyroid disease. In.: Bizollon Ch. A. (Ed.), Radioimmunology. Elsevier North Holland Biomedical Press, Amsterdam, 1979, p. 141.

    Google Scholar 

  24. Madec A.M., Laurent M.C., Lorcy Y., Le Guerridr A.M., Rostagnat — Stefanutti A., Orgiazzi J., Allanic H. Thyroid stimulating antibodies: an aid to the strategy of treatment of Grave’s disease. Clin. Endocrinol (Oxf.) 21: 247, 1984.

    Article  CAS  Google Scholar 

  25. Chopra I.J., Williams D.E., Orgiazzi J., Solomon D.H. Opposite effects of dexamethasone on serum concentration of 3, 3′, 5′ — triodothyronine (reverse T3) and 3, 3′, 5 — triiodothyronine (T3). J. Clin. Endocrinol. Metab. 41: 911, 1975.

    Article  PubMed  CAS  Google Scholar 

  26. Williams D.E., Chopra I.J., Orgiazzi J., Solomon D.H. Acute effects of corticosteroids on thyroid activity in Grave’s disease. J. Clin. Endocrinol. Metab. 41: 354, 1975.

    Article  PubMed  CAS  Google Scholar 

  27. Leger A.F., Fragu P., Rouger P., Laurent M.F., Tubiana M., Savoie J.C. Thyroid iodine content measured by X-ray fluorescence in amiodarone — induced thyrotoxicosis: concise communication. J. Nucl. Med. 24: 582, 1983.

    PubMed  CAS  Google Scholar 

  28. Beishaw B.E., Becker D.E. Necrosis of follicular cells and discharge of thyroidal iodine induced by administering iodide to iodine-deficient dogs. J. Clin. Endocrinol. Metab. 36: 466, 1973.

    Article  Google Scholar 

  29. Smyrk T.C., Goellner J.R., Brennan M.D., Carney J.A. Pathology of the thyroid in amiodarone — associated thyrotoxicosis. Am. J. Surg., Pathol. 11: 197, 1987.

    Article  CAS  Google Scholar 

  30. Amiodarone and the thyroid: the Janus response. Lancet 1: 24, 1987.

  31. Ringrose P.S., Parr M.A., Mc Laren M. Effects of anti-inflammatory and other compounds on the release of lysosomal enzymes from macrophages. J. Biochem. Pharmacol. 24: 607, 1975.

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Service de Médecine Interne, Diabétologie et Endocrinologie, Centre Hospitalier Lyon Sud, Pavillon 5 G, Centre Hospitalier Lyon Sud, 69310, Pierre Bénite, France, 69310, Pierre Benite, France

    Docteur Christiane Broussolle, X. Ducottet, C. Martin, Y. Barbier, H. Bornet, G. Noel & J. Orgiazzi

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  1. Docteur Christiane Broussolle
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  2. X. Ducottet
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  3. C. Martin
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  4. Y. Barbier
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  5. H. Bornet
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  6. G. Noel
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  7. J. Orgiazzi
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Broussolle, D.C., Ducottet, X., Martin, C. et al. Rapid effectiveness of prednisone and thionamides combined therapy in severe amiodarone iodine-induced thyrotoxicosis. Comparison of two groups of patients with apparently normal thyroid glands. J Endocrinol Invest 12, 37–42 (1989). https://doi.org/10.1007/BF03349916

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  • DOI: https://doi.org/10.1007/BF03349916

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