Amiodarone-Induced Elevation of Thyroid Stimulating Hormone in Patients Receiving Levothyroxine for Primary Hypothyroidism
Abstract
Brief Reports1 October 1990Amiodarone-Induced Elevation of Thyroid Stimulating Hormone in Patients Receiving Levothyroxine for Primary HypothyroidismJames Figge, MD, Robert G. Dluhy, MDJames Figge, MD, Robert G. Dluhy, MDAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-113-7-553 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptAmiodarone, an iodinated antiarrhythmic agent, has complex effects on thyroid hormone physiology. As a potent hepatic 5′-deiodinase inhibitor, the drug decreases thyroxine (T4) conversion to 3,5,3′-triiodothyronine (T3), and slows 3,3′,5′-triiodothyronine (rT3) clearance (1-3). Amiodarone may inhibit both the cellular uptake of T3 and T4 (4, 5), and the binding of T3 to its receptor (5, 6). These effects modulate T3-mediated responses in vitro (5-7) and in animals (8). Finally, iodide released from metabolism of the drug may occasionally cause overt hypothyroidism or hyperthyroidism (9). Given the antagonistic effects of amiodarone on T3 action, we studied whether the drug could elevate...References1. BurgerDinichertNicodJennyLemarchand-BeraudVallotton ADPMTM. Effect of amiodarone on serum triiodothyronine, reverse triiodothyronine, thyroxin, and thyrotropin. J Clin Invest. 1976;58:255-9. CrossrefMedlineGoogle Scholar2. MelmedNademaneeReedHendricksonSinghHershman SKAJBJ. Hyperthyroxinemia with bradycardia and normal thyrotropin secretion after chronic amiodarone administration. J Clin Endocrinol Metab. 1981;53:997-1001. CrossrefMedlineGoogle Scholar3. NademaneeSinghCallahanHendricksonHershman KBBJJ. Amiodarone, thyroid hormone indexes, and altered thyroid function: long-term serial effects in patients with cardiac arrhythmias. Am J Cardiol. 1986;58:981-6. CrossrefMedlineGoogle Scholar4. KrenningDocterBernardVisserHennemann ERBTG. Decreased transport of thyroxine (T4), 3,3′,5-triiodothyronine (T3) and 3,3′,5′-triiodothyronine (rT3) into rat hepatocytes in primary culture due to a decrease of cellular ATP content and various drugs. FEBS Lett. 1982;140:229-33. CrossrefMedlineGoogle Scholar5. NormanLavin MT. Antagonism of thyroid hormone action by amiodarone in rat pituitary tumor cells. J Clin Invest. 1989;83:306-13. CrossrefMedlineGoogle Scholar6. FranklynDavisGammageLittlerRamsdenSheppard JJMWDM. Amiodarone and thyroid hormone action. Clin Endocrinol. 1985;22:257-64. CrossrefMedlineGoogle Scholar7. GoldfineMadduxWoeber IBK. Effect of amiodarone on L-triiodothyronine stimulation of [3H]thymidine incorporation into GH3 cells. J Endocrinol Invest. 1982;5:165-8. CrossrefMedlineGoogle Scholar8. FranklynGammageSheppard JMM. Amiodarone and thyroid hormone effects on anterior pituitary hormone gene expression. Clin Endocrinol. 1987;27:373-82. CrossrefMedlineGoogle Scholar9. MartinoSafran EM, Aghini-Lombardi F, et al. Environmental iodine intake and thyroid dysfunction during chronic amiodarone therapy. Ann Intern Med. 1984;101:28-34. LinkGoogle Scholar10. LambertBurgerDe NayerBeckers MAPC. Decreased TSH response to TRH induced by amiodarone. Acta Endocrionologica. 1988;118:449-52. CrossrefMedlineGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: From Brigham and Women's Hospital, Boston, Massachusetts. For current author addresses, see end of text. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byHeart Drugs and Influences on TH MetabolismDrug Effects on the ThyroidAmiodarone-Induced Thyroid DysfunctionHypothyroidism and Myxedema ComaHypothyroidism and ThyroiditisGuidelines for the Treatment of Hypothyroidism: Prepared by the American Thyroid Association Task Force on Thyroid Hormone ReplacementHypothyroidism and ThyroiditisAmiodarone and Thyroid DysfunctionHypothyroidism and Myxedema ComaHypothyroidismPseudomalabsorption de L-thyroxine: une forme de pathomimieRepercusiones del tratamiento con amiodarona sobre la función tiroidea y su manejo actualAmiodarone and the thyroidBiochemistry, Cellular and Molecular Biology, and Physiological Roles of the Iodothyronine SelenodeiodinasesThe Various Effects of Amiodarone on Thyroid FunctionThe Effects of Amiodarone on the Thyroid*Thyroid Hormone Replacement Therapy for Primary and Secondary HypothyroidismAmiodarone and the ThyroidAmiodarone and the thyroid: pharmacological, toxic and therapeutic effects 1 October 1990Volume 113, Issue 7Page: 553-555KeywordsDrug metabolismDrugsEndocrinologyHospital medicineHyperthyroidismHypothyroidismThyroid hormonesThyroid-stimulating hormoneThyroxineTriiodothyronine Issue Published: 1 October 1990 Copyright & Permissions©1990 American College of PhysiciansPDF downloadLoading ...
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A need for increased LT4 dose was reported with initiation of amiodarone therapy in two patients, and amiodarone inhibits D2 in rodents.
“With respect to agents that alter D2 activity, a need for an increased dose of LT4 was reported with initiation of amiodarone therapy in two patients (192), and this drug has been shown to inhibit D2 in rodents (193).”
From Guidelines for the Treatment of Hypothyroidism: Prepared by the American Thyroid Association Task Force on Thyroid Hormone Replacement (2014) · cites this paper as [192]
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- Authors
- Figge, J., & Dluhy, R. G.
- Affiliations
- Brigham and Women's Hospital (US)
- Corresponding author
- Figge, James
- Venue
- Annals of Internal Medicine
- Publisher
- American College of Physicians
- Published
- 1990-10-01
- Volume
- 113
- Issue
- 7
- Pages
- 553-555
- ISSN
- 0003-4819 (ISSN-L)
- 1539-3704
- OpenAlex
- W2094318128
- Cited by
- 30
- References
- 10
- Citations by year
- 2023: 2 · 2022: 2 · 2020: 1 · 2019: 2 · 2016: 1 · 2015: 1 · 2014: 1 · 2013: 1
- FWCI
- 0.63
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Annals of Internal Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Center for Research Resources (RR02635, M01RR002635)
- 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 › Surgery › Thyroid and Parathyroid Surgery
- Keywords
- amiodarone, thyroid-stimulating hormone, levothyroxine, primary hypothyroidism, drug-induced thyroid dysfunction, triiodothyronine, reverse T3, thyroid hormone metabolism, hyperthyroidism, iodide release, antiarrhythmic drugs, thyroid function tests
- MeSH terms
- Aged, Aged, 80 and over, Amiodarone, Female, Humans, Hypothyroidism, Male, Thyroid Hormones, Thyrotropin, Thyroxine
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