US EPA

9089334 

Journal Article 

Treatment of amiodarone-induced thyrotoxicosis, a difficult challenge: results of a prospective study 

Bartalena, L; Brogioni, S; Grasso, L; Bogazzi, F; Burelli, A; Martino, E; , 

1996 

Yes 

Journal of Clinical Endocrinology and Metabolism
ISSN: 0021-972X
EISSN: 1945-7197 

ENDOCRINE SOC 

CHEVY CHASE 

81 

8 

2930-2933 

English 

8768854 

WOS:A1996VC90100033 

Amiodarone-induced thyrotoxicosis (AIT) occurs in both abnormal (type I) and apparently normal (type II) thyroid glands due to iodine-induced excessive thyroid hormone synthesis in patients with nodular goiter or latent Graves' disease (type I) or to a thyroid-destructive process caused by amiodarone or iodine (type II). Twenty-four consecutive AIT patients, 12 type I and 12 type II, were evaluated prospectively. Sex, age, severity of thyrotoxicosis, and cumulative amiodarone dose were similar. Type II patients had higher serum interleukin-6 (IL-6; median, 440 vs. 173 fmol/L; P < 0.001), but lower serum thyroglobulin levels. Several weeks of thionamide therapy in eight type II or prolonged glucocorticoid administration in two type I patients had previously failed to control hyperthyroidism. Type II patients were given prednisone (initial dose, 40 mg/day) for 3 months and achieved normal free T3 and IL-6 after an average of 8 and 6 days, respectively. Exacerbation of thyrotoxicosis with increased serum IL-6 values, observed in 4 patients while tapering steroid, was promptly corrected by increasing it. Type I patients, given methimazole (30 mg/day) and potassium perchlorate (1 g/day), achieved normal free T3 and IL-6 concentrations after an average of 4 weeks. Exacerbation of thyrotoxicosis with markedly increased IL-6 was controlled by prednisone in 3 of 4 cases. Distinction of different forms of AIT is essential for its successful management. Type II AIT should be treated with glucocorticoids; type I AIT should be treated with methimazole and potassium perchlorate. Exacerbation of thyrotoxicosis, which may occur in both forms and is probably related to destructive processes, should be controlled by the addition/increase in glucocorticoids. 

Interleukin-6; Perchlorates; Potassium Compounds; Triiodothyronine; 06LU7C9H1V; potassium perchlorate; 42255P5X4D; Methimazole; 554Z48XN5E; Amiodarone; N3RQ532IUT; Prednisone; VB0R961HZT; Index Medicus; Methimazole -- therapeutic use; Interleukin-6 -- blood; Prospective Studies; Middle Aged; Triiodothyronine -- blood; Potassium Compounds -- therapeutic use; Perchlorates -- therapeutic use; Drug Therapy, Combination; Prednisone -- therapeutic use; Amiodarone -- adverse effects; Thyrotoxicosis -- blood; Thyrotoxicosis -- chemically induced; Thyrotoxicosis -- classification