Thyroid color flow doppler sonography and radioiodine uptake in 55 consecutive patients with amiodarone-induced thyrotoxicosis
Abstract
Amiodarone-induced thyrotoxicosis (AMT) is a life-threatening condition, the appropriate management of which is achieved by identifying its different subtypes. Type 1 AIT develops in patients with underlying thyroid abnormalities and is believed to be due to increased thyroid hormone synthesis and release; Type 2 AIT occurs in patients with a normal thyroid gland and is an amiodarone-induced destructive process of the thyroid. Management differs in the two forms of AIT, since Type 1 usually responds to combined thionamides and potassium perchlorate therapy, while Type 2 is generally responsive to glucocorticoids. Mixed forms, characterized by coexistence of excess thyroid hormone synthesis and destructive phenomena, may require a combination of the two therapeutic regimens. In this cross-sectional prospective study, 55 consecutive untreated patients, whose AIT was subtyped according to clinical and biochemical criteria, were evaluated to assess the specificity of color flow doppler sonography (CFDS) and thyroidal radioiodine uptake (RAIU) in the differential diagnosis of AIT. Sixteen patients (6 men, 10 women, age 66+/-13 yr), who had diffuse or nodular goiter with or without circulating thyroid autoantibodies, were classified as Type 1 AIT; 39 patients (27 men, 12 women, age 65+/-13 yr) with apparently normal thyroids were classified as Type 2 AIT. All Type 1 patients had normal or increased thyroidal vascularity on CFDS, while Type 2 AIT patients had absent vascularity (p<0.0001). Thirteen Type 1 AIT patients had inappropriately normal or elevated thyroidal 3-h and 24-h RAIU values (range 6-37% and 10-58%, respectively), in spite of elevated values of urinary iodine excretion; the remaining 3 patients (two with nodular goiter, one with a thyroid adenoma) had low 3-h and 24-h RAIU values (range 1.1-3.0% and 0.9-4.0%, respectively). The latter patients, who were unresponsive to the combination of methimazole and potassium perchlorate, became euthyroid after the addition of glucocorticoids. Thirty-eight Type 2 AIT patients had low 3-h and 24-h RAIU values (range 0.4-3.7% and 0.2-3.0%, respectively), but one had inappropriately normal 3-h and 24-h RAIU values (6% and 13%, respectively). In conclusion, CFDS can accurately distinguish between Type 1 and Type 2 AIT, and in general the CFDS pattern is concordant with the thyroid RAIU. However, in 4 out of 55 patients (7%) the thyroid RAIU was discrepant, probably reflecting the coexistence of Type 1 and Type 2 AIT. Thus, assessment of both CFDS and RAIU may provide a more accurate subtyping of AIT and help in selecting the appropriate therapy. Finally, in long standing iodine sufficient areas, such as the United States, where the thyroid RAIU is consistently low irrespective of the etiology of the AIT, CFDS offers a rapid and available method to differentiate between Type 1 and Type 2 AIT.
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Several studies have shown that increased vascularity on CFDS may be seen in patients with type 1, but not type 2 AIT.
“Several studies have shown that increased vascularity on CFDS may be seen in patients with type 1, but not type 2 AIT (599-601).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [599]
In a series of 55 patients, 81.3% of patients determined to have type 1 AIT had pattern I vascularity (the lowest level above zero).
“In a series of 55 patients in whom a CFDS qualitative assessment of vascular flow was used to distinguish type 1 from type 2 AIT, 81.3% of patients determined to have type 1 AIT had pattern I vascularity (the lowest level above zero), illustrating the skill and nuance needed to successfully make this distinction (599).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [599]
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“3% of patients determined to have type 1 AIT had pattern I vascularity (the lowest level above zero), illustrating the skill and nuance needed to successfully make this distinction (599).”
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- Authors
- Bogazzi, F., Martino, E., Dell’Unto, E., Brogioni, S., Cosci, C., Aghini-Lombardi, F., Ceccarelli, C., Pinchera, A., Bartalena, L., & Braverman, L. E.
- Affiliations
- University of Pisa (IT)
- University of Insubria (IT)
- Boston Medical Center (US)
- Corresponding author
- Bogazzi, F.
- Venue
- Journal of Endocrinological Investigation
- Published
- 2003-07
- Volume
- 26
- Issue
- 7
- Pages
- 635-640
- ISSN
- 0391-4097 (ISSN-L)
- 1720-8386
- OpenAlex
- W2078541861
- Cited by
- 71
- References
- 31
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 2 · 2023: 1 · 2022: 1 · 2021: 6 · 2020: 2 · 2019: 5 · 2018: 3 · 2017: 4 · 2016: 2 · 2015: 3 · 2014: 3 · 2013: 4 · 2012: 4
- FWCI
- 1.42
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Journal of Endocrinological Investigation (publishedVersion)
- PubMed (publishedVersion)
- CINECA IRIS Institutial research information system (University of Pisa) (submittedVersion)
- IrInSubria (University of Insubria) (submittedVersion)
- Funders
- Università degli Studi dell'Insubria
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Cancer Diagnosis and Treatment
- Health Sciences › Medicine › Pathology and Forensic Medicine › Ophthalmology and Eye Disorders
- Keywords
- amiodarone-induced thyrotoxicosis, color flow Doppler sonography, thyroid vascularity, radioiodine uptake, differential diagnosis, thyroid autoantibodies, goiter, thyroid adenoma, glucocorticoid therapy, methimazole, potassium perchlorate, iodine
- MeSH terms
- Adult, Aged, Aged, 80 and over, Amiodarone, Anti-Arrhythmia Agents, Diagnosis, Differential, Female, Humans, Iodine, Iodine Radioisotopes, Male, Middle Aged, Prospective Studies, Radionuclide Imaging, Thyroid Gland, Thyroid Hormones, Thyrotoxicosis, Cross-Over Studies, Ultrasonography, Doppler, Color
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