An audit of amiodarone-induced thyrotoxicosis--do anti-thyroid drugs alone provide adequate treatment?
Heart Lung Circ
; 23(6): 549-54, 2014 Jun.
Article
em En
| MEDLINE
| ID: mdl-24613043
ABSTRACT
INTRODUCTION:
Amiodarone is a widely used anti-arrhythmic drug. A common long-term complication is amiodarone-induced thyrotoxicosis (AIT). We examined retrospectively the efficacy of anti-thyroid drugs with or without prednisolone and the role of surgical thyroidectomy in the treatment of AIT in a single centre, in an iodine-replete region of Australia.METHODS:
A retrospective audit of patients with AIT was performed between 2002-2012 at this centre. Twenty-seven patients, mean age 60.9 ± 2.3 years were identified. Medical therapy (anti-thyroid drugs, prednisolone) was commenced according to the treating endocrinologist. The main outcomes were time to euthyroidism and number proceeding to thyroidectomy.RESULTS:
Of 11 patients commenced on anti-thyroid drugs alone, seven (64%) required the addition of prednisolone. Baseline free T4 was significantly higher in those ultimately treated with prednisolone (58.4 ± 6.3pmol/L) versus those not (31.7 ± 3.4pmol/L, P<0.05). Although similar results were seen with free T3, the difference was not significant (P=0.06). In patients with baseline free T4 <30pmol/L, 75% (3/4) achieved euthyroidism without prednisolone. Neither the use of prednisolone nor continuation of amiodarone significantly influenced time to euthyroidism. Eleven patients (41%) proceeded to surgical thyroidectomy, which was undertaken by an experienced surgical team without significant complications and no mortality.CONCLUSION:
Patients with AIT generally required glucocorticoids. Mild disease (free T4 <30pmol/L) may be successfully treated with anti-thyroid drugs alone. Surgical thyroidectomy is a safe and effective treatment for those refractive to medical therapy.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Antitireóideos
/
Tireotoxicose
/
Amiodarona
/
Auditoria Médica
/
Antiarrítmicos
Tipo de estudo:
Observational_studies
Limite:
Female
/
Humans
/
Middle aged
País/Região como assunto:
Oceania
Idioma:
En
Ano de publicação:
2014
Tipo de documento:
Article