A Stepwise Approach to the Treatment of Amiodarone-Induced Thyrotoxicosis
Abstract
Amiodarone-induced thyrotoxicosis (AIT) is a complex therapeutic challenge. Two major forms have been described: type I and type II. Methimazole (MMI) and potassium perchlorate (KCLO(4)) is the treatment of choice for the former, whereas corticosteroids are used for the latter. However, mixed forms appear frequently and it is not easy to prescribe corticosteroids because of side effects. The present study investigated the validity of a stepwise therapeutic approach to AIT. Twenty patients with AIT were given 30-50 mg/d of MMI and 1000 mg/d of KCLO(4) initially for a month. Euthyroidism or a significant decrease in serum thyroid hormone levels could be achieved in 12 of the patients (7 with type I, 5 type II). Prednisolone, 40-48 mg/d was added for the 8 nonresponding patients (7 type I, 1 type II) and euthyroidism was achieved in all. The prednisolone dose was decreased when free thyroxine (T(4)) levels normalized, and MMI was titrated, maintaining euthyroidism until urinary iodine excretion normalized. Mixed forms of AIT may prevail in iodine-deficient areas. Initial classification of the patients may cause unnecessary corticosteroid use in a substantial number of patients with AIT. A stepwise approach is feasible; however, when the patient is gravely ill, MMI, KCLO(4), and prednisolone could be prescribed simultaneously.
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In a study of 20 patients with AIT that included both type 1 and type 2 patients, perchlorate was administered alone for 1 month, resulting in euthyroidism in 12 patients (seven with type 1 AIT and five with type 2 AIT).
“In a study of 20 patients with AIT that included both type 1 and type 2 patients, perchlorate was administered alone for 1 month, resulting in euthyroidism in 12 patients (seven with type 1 AIT and five with type 2 AIT) (591).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [591]
Corticosteroids were then given to the eight nonresponders (including seven patients with presumed type 1 disease), and euthyroidism was achieved in all after an average of approximately 6 weeks.
“Corticosteroids were then given to the eight nonresponders (including seven patients with presumed type 1 disease), and euthyroidism was achieved in all after an average of approximately 6 weeks (591).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [591]
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- Authors
- Erdoğan, M. F., Güleç, S., Tutar, E., Başkal, N., & Erdoğan, G.
- Affiliations
- Ankara University (TR)
- Venue
- Thyroid
- Publisher
- SAGE Publications
- Published
- 2003-02
- Volume
- 13
- Issue
- 2
- Pages
- 205-209
- ISSN
- 1050-7256 (ISSN-L)
- 1557-9077
- OpenAlex
- W2101314439
- Cited by
- 42
- References
- 28
- Citations by year
- 2024: 2 · 2023: 1 · 2022: 1 · 2021: 1 · 2019: 2 · 2018: 2 · 2017: 1 · 2016: 3 · 2015: 1 · 2014: 2 · 2013: 4 · 2012: 3
- FWCI
- 0.87
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Thyroid (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Health Sciences › Medicine › Pathology and Forensic Medicine › Ophthalmology and Eye Disorders
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
- Keywords
- amiodarone-induced thyrotoxicosis, stepwise treatment, methimazole, potassium perchlorate, prednisolone, corticosteroids, urinary iodine excretion, iodine deficiency
- MeSH terms
- Amiodarone, Anti-Arrhythmia Agents, Anti-Inflammatory Agents, Antibodies, Female, Humans, Iodides, Iodine, Male, Methimazole, Middle Aged, Perchlorates, Prednisolone, Prospective Studies, Antithyroid Agents, Thyroid Gland, Thyrotoxicosis, Thyroxine, Ultrasonography, Potassium Compounds
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