An audit of amiodarone-induced thyrotoxicosis - do anti-thyroid drugs alone provide adequate treatment?

Patel, Nadia, Inder, Warrick J., Sullivan, Clair and Kaye, Gerald (2014) An audit of amiodarone-induced thyrotoxicosis - do anti-thyroid drugs alone provide adequate treatment?. Heart, Lung and Circulation, 23 6: 549-554. doi:10.1016/j.hlc.2014.01.013

Author Patel, Nadia
Inder, Warrick J.
Sullivan, Clair
Kaye, Gerald
Title An audit of amiodarone-induced thyrotoxicosis - do anti-thyroid drugs alone provide adequate treatment?
Journal name Heart, Lung and Circulation   Check publisher's open access policy
ISSN 1443-9506
Publication date 2014-06
Sub-type Article (original research)
DOI 10.1016/j.hlc.2014.01.013
Open Access Status
Volume 23
Issue 6
Start page 549
End page 554
Total pages 6
Place of publication Chatswood, NSW, Australia
Publisher Elsevier
Collection year 2015
Language eng
Formatted abstract
Introduction: Amiodarone is a widely used anti-arrhythmic drug. A common long-term complication is amiodaroneinduced thyrotoxicosis (AIT). We examined retrospectively the efficacy of anti-thyroid drugs with or without prednisolone and the role of surgical thyroidectomy in the treatment of AIT in a single centre, in an iodine-replete region of Australia.

Methods: A retrospective audit of patients with AIT was performed between 2002-2012 at this centre. Twenty-seven patients, mean age 60.9 ± 2.3 years were identified. Medical therapy (anti-thyroid drugs, prednisolone) was commenced according to the treating endocrinologist. The main outcomes were time to euthyroidism and number proceeding to thyroidectomy.

Results: Of 11 patients commenced on anti-thyroid drugs alone, seven (64%) required the addition of prednisolone. Baseline free T4 was significantly higher in those ultimately treated with prednisolone (58.4 ± 6.3 pmol/L) versus those not (31.7 ± 3.4 pmol/L, P<0.05). Although similar results were seen with free T3, the difference was not significant (P=0.06). In patients with baseline free T4 <30 pmol/L, 75% (3/4) achieved euthyroidism without prednisolone. Neither the use of prednisolone nor continuation of amiodarone significantly influenced time to euthyroidism. Eleven patients (41%) proceeded to surgical thyroidectomy, which was undertaken by an experienced surgical team without significant complications and no mortality.

Conclusion: Patients with AIT generally required glucocorticoids. Mild disease (free T4 <30 pmol/L) may be successfully treated with anti-thyroid drugs alone. Surgical thyroidectomy is a safe and effective treatment for those refractive to medical therapy.
Keyword Amiodarone
Ventricular tachycardia
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2015 Collection
School of Medicine Publications
Version Filter Type
Citation counts: TR Web of Science Citation Count  Cited 0 times in Thomson Reuters Web of Science Article
Scopus Citation Count Cited 0 times in Scopus Article
Google Scholar Search Google Scholar
Created: Sun, 27 Jul 2014, 00:03:50 EST by System User on behalf of School of Medicine