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 withdrewamiodarone. 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.
RCT Entities:
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.
Authors: L Tomisti; C Urbani; G Rossi; F Latrofa; C Sardella; L Manetti; I Lupi; C Marcocci; L Bartalena; O Curzio; E Martino; F Bogazzi Journal: J Endocrinol Invest Date: 2016-01-13 Impact factor: 4.256
Authors: E A Troshina; E A Panfilova; M S Mikhina; I V Kim; E S Senyushkina; A A Glibka; B M Shifman; A A Larina; M S Sheremeta; M V Degtyarev; P O Rumyanstsev; N S Kuznetzov; G A Melnichenko; I I Dedov Journal: Probl Endokrinol (Mosk) Date: 2021-04-12
Authors: Jennifer M Yamamoto; Pamela M Katz; James A F Bras; Leigh Anne Shafer; Alexander A Leung; Amir Ravandi; Francisco J Cordova Journal: Health Sci Rep Date: 2018-04-16