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Amiodarone-Induced Thyroid Dysfunction

  • Simone De Leo
  • Lewis E. BravermanEmail author
Chapter

Abstract

Amiodarone is an antiarrhythmic drug, containing 37% iodine by weight, and with structural similarities to thyroid hormones. Amiodarone-induced thyroid dysfunction occurs in 15–20% of patients and includes amiodarone-induced hypothyroidism (AIH) and amiodarone-induced thyrotoxicosis (AIT). AIH is due to failure to escape from the acute Wolff-Chaikoff effect and is easily treated with levothyroxine replacement without requiring amiodarone withdrawal. There are two types of AIT: type 1 AIT, a form of iodine-induced thyrotoxicosis that develops in patients with underlying thyroid disease exposed to the high iodine content of amiodarone, and type 2 AIT, a drug-induced destructive thyroiditis caused by a direct cytotoxic effect of amiodarone. In some cases both pathogeneses coexist and these forms are called mixed forms. Differential diagnosis between AIT types is important since therapy differs. Type 1 AIT is treated with thionamide and in some cases by adding potassium perchlorate; type 2 AIT is treated with glucocorticoids; mixed forms may benefit from the combination of thionamide and glucocorticoids. Patients who are resistant to the other forms of treatment or who need a rapid restoration of euthyroidism should be treated by thyroidectomy. Radioactive iodine is usually not feasible, since these patients have a low radioiodine uptake. Monitoring of thyroid function should be performed before starting amiodarone and then every 3 months during amiodarone therapy and up to at least 2 years after amiodarone withdrawal.

Keyword

Hypo- and hyperthyroidism induced by amiodarone 

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Endocrine UnitFondazione IRCCS Cà GrandaMilanItaly
  2. 2.Department of Clinical Sciences and Community HealthUniversity of MilanMilanItaly
  3. 3.Section of Endocrinology, Diabetes and NutritionBoston University School of MedicineBostonUSA

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