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Cited by 59Thyroid Disorders and TreatmentsAdrenal Hormones and DisordersOphthalmology and Eye Disorders

Continuation of Amiodarone Delays Restoration of Euthyroidism in Patients with Type 2 Amiodarone-Induced Thyrotoxicosis Treated with Prednisone: A Pilot Study

Bogazzi, Fausto, Bartalena, Luigi, Tomisti, Luca, Rossi, Giuseppe, Brogioni, Sandra, Martino, Enio·2011·The Journal of Clinical Endocrinology & Metabolism
DOI 10.1210/jc.2011-1678
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Abstract

CONTEXT: Type 2 amiodarone-induced thyrotoxicosis (AIT) is a destructive thyroiditis usually responsive to glucocorticoids. Whether continuation of amiodarone affects treatment outcome is unsettled. OBJECTIVE: The objective of the study was to compare the outcome of glucocorticoid treatment in type 2 AIT patients who continued or withdrew amiodarone. DESIGN: This was a matched retrospective cohort study. SETTING: The study was conducted at a university center. PATIENTS: Eighty-three consecutive patients with untreated type 2 AIT participated in the study. After matching with patients continuing amiodarone (AMIO-ON, n = 8), patients interrupting amiodarone were randomly selected in a 4:1 ratio (AMIO-OFF, n = 32). INTERVENTION: All patients were treated with oral prednisone. Patients whose thyrotoxicosis recurred after glucocorticoid withdrawal were treated with a second course of prednisone. MAIN OUTCOME MEASURE: Time and rate of cure were measured. RESULTS: Median time to the first normalization of serum thyroid hormone levels did not significantly differ in AMIO-ON and AMIO-OFF patients (24 and 31 d, respectively; P = 0.326). Conversely, median time for stably restoring euthyroidism was 140 d in AMIO-ON patients and 47 d in AMIO-OFF patients (log rank, P = 0.011). In fact, AIT recurred in five of seven AMIO-ON patients (71.4%) and in only three of 32 AMIO-OFF patients (9.4%, P = 0.002), requiring readministration of prednisone. One AMIO-ON patient never reached thyroid hormone normalization during the study period. Factors associated with glucocorticoid failure were thyroid volume and amiodarone continuation. CONCLUSIONS: Prednisone restores euthyroidism in most type 2 AIT patients, irrespective of amiodarone continuation or withdrawal. However, continuing amiodarone increases the recurrence rate of thyrotoxicosis, causing a delay in the stable restoration of euthyroidism and a longer exposure of the heart to thyroid hormone excess.

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Authors
Bogazzi, F., Bartalena, L., Tomisti, L., Rossi, G., Brogioni, S., & Martino, E.
Affiliations
  • University of Pisa (IT)
  • University of Insubria (IT)
  • Istituto di Fisiologia Clinica (IT)
Corresponding author
Bogazzi, Fausto
ORCID
Venue
The Journal of Clinical Endocrinology & Metabolism
Publisher
The Endocrine Society
Published
2011-11
Volume
96
Issue
11
Pages
3374-3380
ISSN
  • 0021-972X (ISSN-L)
  • 1945-7197
DOI
10.1210/jc.2011-1678
OpenAlex
W2090239473
Cited by
59
References
26
Citations by year
2026: 4 · 2024: 6 · 2023: 2 · 2022: 4 · 2021: 3 · 2020: 5 · 2019: 2 · 2018: 6 · 2017: 3 · 2016: 4 · 2015: 1 · 2014: 7 · 2013: 4 · 2012: 6
FWCI
4.72
Type
journal article
Language
en
Open access
closed
Locations
  • The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
  • PubMed (publishedVersion)
  • CINECA IRIS Institutial research information system (University of Pisa) (submittedVersion)
  • IrInSubria (University of Insubria) (submittedVersion)
Funders
Università di Pisa
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
  • Health Sciences › Medicine › Pathology and Forensic Medicine › Ophthalmology and Eye Disorders
Keywords
prednisone, glucocorticoid therapy, destructive thyroiditis, thyroid volume, drug interactions
MeSH terms
Aged, Aged, 80 and over, Amiodarone, Anti-Arrhythmia Agents, Female, Glucocorticoids, Humans, Male, Middle Aged, Pilot Projects, Prednisone, Retrospective Studies, Thyrotoxicosis, Cohort Studies, Treatment Outcome

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