Alterations in thyroid function induced by chronic administration of amiodarone.

Thyroid function alterations induced by amiodarone treatment (200-400 mg/day for 5 days/week) were studied in 50 patients with heart disease (age 34-75 years, mean age 55.5 +/- 11.8) for 25.6 +/- 15.0 months. Statistical analysis was made of the results obtained from the 14 patients who underwent all of the schedule examinations during the same 16-month period. A reduction in T3 was observed after 7 days' treatment; this became statistically significant at 12 and 16 months. FT3 fell significantly only after 7 days; rT3 showed an opposite trend to that of T3 (low T3 syndrome), with significant increases at all observation times. TSH rose at 7 days, then fell gradually to below baseline values after 12 months. No evidence of clinical hyperthyroidism accompanied the significant increases of T4 and FT4 observed at 1, 3, 6, and 16 months; when this complication occurred (in 6% of the cases) it was associated with a rise or lack of reduction in T3 levels. In these cases treatment was withdrawn. Amiodarone was also discontinued in 2 other cases (4%) with elevated thyroid function indices but without clinical symptoms. Seven patients who showed an isolated increase of FT3 were carefully monitored; only in one case did clinical hyperthyroidism develop with a simultaneous rise in the T3 level. A diagnosis of hypothyroidism may be considered only if there is a reduction in T4 levels, since an isolated increase in TSH is not as reliable; treatment had to be suspended for this reason in 2 cases (4%), both without clinical symptoms.(ABSTRACT TRUNCATED AT 250 WORDS)

[Role of M-mode and 2-dimensional (sector-scan) echocardiography in studying postinfarct ventricular kinetic changes]. / Ruolo dell'ecocardiografia unidimensionale e bidimensionale (sector-scan) nello studio delle cinesi ventricolare post-infartuale.

20 patients with previous myocardial infarction clinically suspected to have large impairment of ventricular wall kinesis were studied to evaluate the contribution of M-mode and two-dimensional echocardiography compared with the cineangiographic study in detecting left ventricular asynergy. Two-dimensional cross-sectional echocardiography yielded a satisfactory overlapping of results with ventriculography as far as left ventricular internal dimension and apical and posterior wall kinesis were concerned. The two-dimensional study proved to be an useful technique to observe the interventricular septum, in all its extension and the lateral wall as well. The M-mode technique, on the other hand, provided a reliable method, by means of the mitral valve echo, to determine the presence of elevated left-ventricular end-diastolic pressure; this was indicated by the occurrence of a B point, on the AC slope. A late opening of the mitral valve compared with the onset of left ventricular posterior wall relaxation phase, and other anomalies observed on the CD slope (SAM or pseudo-SAM), indicated pathological left ventricular kinesis. The failure of the left ventricular posterior wall to reach the septum moving the transducer from the aorta to the cardiac apex was considered indicative of apical dilatation, even if limited by a great number of false negatives. M-mode echocardiography provided also a quantitative evaluation of septal and postero-basal wall movement (particularly important from a prognostic point of view) and left ventricular end-diastolic dimension which, if corrected by body surface, resulted similar to those obtained by the two-dimensional technique. M-mode and Two-dimensional cross sectional echocardiography appeared to be complementary techniques which allow an adequate evaluation and diagnosis of left ventricular asynergy. They seem to be particularly useful to follow prospectively patients affected by myocardial infarction.