Skip to main content

Advertisement

SpringerLink
Log in

Amiodarone-related thyroid dysfunction

  • IM - REVIEW
  • Published:
Internal and Emergency Medicine Aims and scope Submit manuscript

Abstract

Nowadays, amiodarone is the most commonly used antidysrhythmic drug in clinical practice. It is highly effective in the management of recurrent ventricular dysrhythmias, paroxysmal supraventricular dysrhythmias, including atrial fibrillation and flutter, and in the maintenance of sinus rhythm after electrical cardioversion of atrial fibrillation. Moreover, it has the added benefit of being well tolerated in patients with both normal and impaired left ventricular systolic function. Despite amiodarone’s potent antidysrhythmic actions, its use is hampered by numerous adverse effects on various organs, including the thyroid. Adverse effects are becoming more prevalent given the increasing incidence of dysrhythmias and wider amiodarone use. Thus, physicians and patients should both be aware of the potential thyroid-specific sequelae. However, amiodarone is likely to remain a significant problem for endocrinologists as concerns exist over the use of the new alternative antiarrhythmic agent, dronedarone, especially in patients with heart failure and left ventricular dysfunction because of the risk of hepatic injury and increased mortality. The final diagnostic and therapeutic approaches must be discussed among the patient, the general practitioner, the cardiologist, and the endocrinologist.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Singh BN, Vaughan Williams EM (1970) The effect of amiodarone, a new anti-anginal drug, on cardiac muscle. Br J Pharmacol 39(4):657–667

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  2. Singh BN (2008) Amiodarone as paradigm for developing new drugs for atrial fibrillation. J Cardiovasc Pharmacol 52(4):300–305. doi:10.1097/FJC.0b013e31818914b6

    Article  CAS  PubMed  Google Scholar 

  3. van Erven L, Schalij MJ (2010) Amiodarone: an effective antiarrhythmic drug with unusual side effects. Heart 96(19):1593–1600. doi:10.1136/hrt.2008.152652 (pii: 96/19/1593)

    Article  PubMed  Google Scholar 

  4. Goldschlager N, Epstein AE, Naccarelli GV, Olshansky B, Singh B, Collard HR, Murphy E (2007) A practical guide for clinicians who treat patients with amiodarone: 2007. Heart Rhythm 4(9):1250–1259. doi:10.1016/j.hrthm.2007.07.020

    Article  PubMed  Google Scholar 

  5. Camm AJ, Lip GY, De Caterina R, Savelieva I, Atar D, Hohnloser SH, Hindricks G, Kirchhof P (2012) 2012 focused update of the ESC Guidelines for the management of atrial fibrillation: an update of the 2010 ESC Guidelines for the management of atrial fibrillation. Developed with the special contribution of the European Heart Rhythm Association. Eur Heart J 33(21):2719–2747. doi:10.1093/eurheartj/ehs253

    Article  PubMed  Google Scholar 

  6. Preedy VR, Burrow GN, Watson RR (2009) Comprehensive handbook of iodine : nutritional, biochemical, pathological and therapeutic aspects. Elsevier, London

    Google Scholar 

  7. Hudzik B, Zubelewicz-Szkodzinska B (2014) Radiocontrast-induced thyroid dysfunction: is it common and what should we do about it? Clin Endocrinol (Oxf) 80(3):322–327. doi:10.1111/cen.12376

    Article  Google Scholar 

  8. Rao RH, McCready VR, Spathis GS (1986) Iodine kinetic studies during amiodarone treatment. J Clin Endocrinol Metab 62(3):563–568. doi:10.1210/jcem-62-3-563

    Article  CAS  PubMed  Google Scholar 

  9. Eskes SA, Wiersinga WM (2009) Amiodarone and thyroid. Best Pract Res Clin Endocrinol Metab 23(6):735–751. doi:10.1016/j.beem.2009.07.001

    Article  CAS  PubMed  Google Scholar 

  10. Leung AM, Braverman LE (2012) Iodine-induced thyroid dysfunction. Curr Opin Endocrinol Diabetes Obes 19(5):414–419. doi:10.1097/MED.0b013e3283565bb2

    Article  CAS  PubMed  Google Scholar 

  11. Cohen-Lehman J, Dahl P, Danzi S, Klein I (2010) Effects of amiodarone therapy on thyroid function. Nat Rev Endocrinol 6(1):34–41. doi:10.1038/nrendo.2009.225 (pii: nrendo.2009.225)

    Article  CAS  PubMed  Google Scholar 

  12. Latini R, Tognoni G, Kates RE (1984) Clinical pharmacokinetics of amiodarone. Clin Pharmacokinet 9(2):136–156. doi:10.2165/00003088-198409020-00002

    Article  CAS  PubMed  Google Scholar 

  13. Vassallo P, Trohman RG (2007) Prescribing amiodarone: an evidence-based review of clinical indications. JAMA 298(11):1312–1322. doi:10.1001/jama.298.11.1312

    Article  CAS  PubMed  Google Scholar 

  14. Lafuente-Lafuente C, Alvarez JC, Leenhardt A, Mouly S, Extramiana F, Caulin C, Funck-Brentano C, Bergmann JF (2009) Amiodarone concentrations in plasma and fat tissue during chronic treatment and related toxicity. Br J Clin Pharmacol 67(5):511–519. doi:10.1111/j.1365-2125.2009.03381.x

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  15. Greenberg ML, Lerman BB, Shipe JR, Kaiser DL, DiMarco JP (1987) Relation between amiodarone and desethylamiodarone plasma concentrations and electrophysiologic effects, efficacy and toxicity. J Am Coll Cardiol 9(5):1148–1155

    Article  CAS  PubMed  Google Scholar 

  16. Tsadok MA, Jackevicius CA, Rahme E, Essebag V, Eisenberg MJ, Humphries KH, Tu JV, Behlouli H, Joo J, Pilote L (2011) Amiodarone-induced thyroid dysfunction: brand-name versus generic formulations. CMAJ 183(12):E817–E823. doi:10.1503/cmaj.101800

    Article  PubMed Central  PubMed  Google Scholar 

  17. Newman CM, Price A, Davies DW, Gray TA, Weetman AP (1998) Amiodarone and the thyroid: a practical guide to the management of thyroid dysfunction induced by amiodarone therapy. Heart 79(2):121–127

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  18. Ursella S, Testa A, Mazzone M, Gentiloni Silveri N (2006) Amiodarone-induced thyroid dysfunction in clinical practice. Eur Rev Med Pharmacol Sci 10(5):269–278

    CAS  PubMed  Google Scholar 

  19. Iervasi G, Clerico A, Bonini R, Manfredi C, Berti S, Ravani M, Palmieri C, Carpi A, Biagini A, Chopra IJ (1997) Acute effects of amiodarone administration on thyroid function in patients with cardiac arrhythmia. J Clin Endocrinol Metab 82(1):275–280. doi:10.1210/jcem.82.1.3675

    Article  CAS  PubMed  Google Scholar 

  20. Basaria S, Cooper DS (2005) Amiodarone and the thyroid. Am J Med 118(7):706–714 (pii: S0002-9343(05)00219-6)

    Article  CAS  PubMed  Google Scholar 

  21. Narayana SK, Woods DR, Boos CJ (2011) Management of amiodarone-related thyroid problems. Ther Adv Endocrinol Metab 2(3):115–126. doi:10.1177/2042018811398516

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  22. Bogazzi F, Tomisti L, Bartalena L, Aghini-Lombardi F, Martino E (2012) Amiodarone and the thyroid: a 2012 update. J Endocrinol Invest 35(3):340–348. doi:10.3275/8298

    CAS  PubMed  Google Scholar 

  23. Martino E, Safran M, Aghini-Lombardi F, Rajatanavin R, Lenziardi M, Fay M, Pacchiarotti A, Aronin N, Macchia E, Haffajee C et al (1984) Environmental iodine intake and thyroid dysfunction during chronic amiodarone therapy. Ann Intern Med 101(1):28–34

    Article  CAS  PubMed  Google Scholar 

  24. Tanda ML, Piantanida E, Lai A, Liparulo L, Sassi L, Bogazzi F, Wiersinga WM, Braverman LE, Martino E, Bartalena L (2008) Diagnosis and management of amiodarone-induced thyrotoxicosis: similarities and differences between North American and European thyroidologists. Clin Endocrinol (Oxf) 69(5):812–818. doi:10.1111/j.1365-2265.2008.03268.x

    Article  Google Scholar 

  25. Trip MD, Wiersinga W, Plomp TA (1991) Incidence, predictability, and pathogenesis of amiodarone-induced thyrotoxicosis and hypothyroidism. Am J Med 91(5):507–511

    Article  CAS  PubMed  Google Scholar 

  26. Markou K, Georgopoulos N, Kyriazopoulou V, Vagenakis AG (2001) Iodine-Induced hypothyroidism. Thyroid 11(5):501–510. doi:10.1089/105072501300176462

    Article  CAS  PubMed  Google Scholar 

  27. Porter RS, Kaplan JL (2011) The Merck manual of diagnosis and therapy, 19th edn. Merck Sharp & Dohme, Whitehouse Station

    Google Scholar 

  28. Loh KC (2000) Amiodarone-induced thyroid disorders: a clinical review. Postgrad Med J 76(893):133–140

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  29. Bogazzi F, Bartalena L, Tomisti L, Dell’Unto E, Cosci C, Sardella C, Tanda ML, Lai A, Gasperi M, Aghini-Lombardi F, Martino E (2008) Potassium perchlorate only temporarily restores euthyroidism in patients with amiodarone-induced hypothyroidism who continue amiodarone therapy. J Endocrinol Invest 31(6):515–519 (pii: 4635)

    Article  CAS  PubMed  Google Scholar 

  30. Barlow JW, Weetman AP, Grossman A (1997) Pharmacotherapeutics of the thyroid gland. Handbook of experimental pharmacology, vol 128. Springer, Berlin

    Google Scholar 

  31. Zimmermann MB, Andersson M (2012) Update on iodine status worldwide. Curr Opin Endocrinol Diabetes Obes 19(5):382–387. doi:10.1097/MED.0b013e328357271a

    Article  CAS  PubMed  Google Scholar 

  32. Andersson M, de Benoist B, Darnton-Hill I, Delange F (2007) iodine deficiency in Europe: a continuing public helath problem. World Health Organization, Geneva

    Google Scholar 

  33. Cardenas GA, Cabral JM, Leslie CA (2003) Amiodarone induced thyrotoxicosis: diagnostic and therapeutic strategies. Cleve Clin J Med 70(7):624–626 (628–631)

    Article  PubMed  Google Scholar 

  34. Carpi A, Cini G, Russo M, Antonelli A, Gaudio C, Galetta F, Franzoni F, Rossi G (2013) Subclinical hyperthyroidism and cardiovascular manifestations: a reevaluation of the association. Intern Emerg Med 8(Suppl 1):S75–S77. doi:10.1007/s11739-013-0913-2

    Article  PubMed  Google Scholar 

  35. Piga M, Cocco MC, Serra A, Boi F, Loy M, Mariotti S (2008) The usefulness of 99mTc-sestaMIBI thyroid scan in the differential diagnosis and management of amiodarone-induced thyrotoxicosis. Eur J Endocrinol 159(4):423–429. doi:10.1530/EJE-08-0348

    Article  CAS  PubMed  Google Scholar 

  36. Piga M, Serra A, Boi F, Tanda ML, Martino E, Mariotti S (2008) Amiodarone-induced thyrotoxicosis. A review. Minerva Endocrinol 33(3):213–228

    CAS  PubMed  Google Scholar 

  37. Tomisti L, Rossi G, Bartalena L, Martino E, Bogazzi F (2014) The onset time of amiodarone-induced thyrotoxicosis (AIT) depends on AIT type. Eur J Endocrinol 171(3):363–368. doi:10.1530/EJE-14-0267

    Article  CAS  PubMed  Google Scholar 

  38. Yiu KH, Jim MH, Siu CW, Lee CH, Yuen M, Mok M, Shea YF, Fan K, Tse HF, Chow WH (2009) Amiodarone-induced thyrotoxicosis is a predictor of adverse cardiovascular outcome. J Clin Endocrinol Metab 94(1):109–114. doi:10.1210/jc.2008-1907

    Article  CAS  PubMed  Google Scholar 

  39. Rajeswaran C, Shelton RJ, Gilbey SG (2003) Management of amiodarone-induced thyrotoxicosis. Swiss Med Wkly 133(43–44):579–585

    CAS  PubMed  Google Scholar 

  40. Bogazzi F, Bartalena L, Martino E (2010) Approach to the patient with amiodarone-induced thyrotoxicosis. J Clin Endocrinol Metab 95(6):2529–2535. doi:10.1210/jc.2010-0180

    Article  CAS  PubMed  Google Scholar 

  41. Tsang W, Houlden RL (2009) Amiodarone-induced thyrotoxicosis: a review. Can J Cardiol 25(7):421–424

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  42. Dickstein G, Shechner C, Adawi F, Kaplan J, Baron E, Ish-Shalom S (1997) Lithium treatment in amiodarone-induced thyrotoxicosis. Am J Med 102(5):454–458

    Article  CAS  PubMed  Google Scholar 

  43. Uzzan B, Pussard E, Leon A, Bekhechi D, Krivitzky A, Modigliani E, Perret G, Vassy R, Berdeaux A, Giudicelli JF (1991) The effects of plasmapheresis on thyroid hormone and plasma drug concentrations in amiodarone-induced thyrotoxicosis. Br J Clin Pharmacol 31(3):371–372

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  44. Diamond TH, Rajagopal R, Ganda K, Manoharan A, Luk A (2004) Plasmapheresis as a potential treatment option for amiodarone-induced thyrotoxicosis. Intern Med J 34(6):369–370. doi:10.1111/j.1444-0903.2004.00600.x

    Article  CAS  PubMed  Google Scholar 

  45. Shemin D, Briggs D, Greenan M (2007) Complications of therapeutic plasma exchange: a prospective study of 1,727 procedures. J Clin Apher 22(5):270–276. doi:10.1002/jca.20143

    Article  PubMed  Google Scholar 

  46. Bogazzi F, Bartalena L, Tomisti L, Rossi G, Brogioni S, Martino E (2011) Continuation of amiodarone delays restoration of euthyroidism in patients with type 2 amiodarone-induced thyrotoxicosis treated with prednisone: a pilot study. J Clin Endocrinol Metab 96(11):3374–3380. doi:10.1210/jc.2011-1678

    Article  CAS  PubMed  Google Scholar 

  47. Naccarelli GV, Wolbrette DL, Levin V, Samii S, Banchs JE, Penny-Peterson E, Gonzalez MD (2011) Safety and efficacy of dronedarone in the treatment of atrial fibrillation/flutter. Clin Med Insights Cardiol 5:103–119. doi:10.4137/CMC.S6677

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  48. Yalta K, Turgut OO, Yilmaz MB, Yilmaz A, Tandogan I (2009) Dronedarone: a promising alternative for the management of atrial fibrillation. Cardiovasc Drugs Ther 23(5):385–393. doi:10.1007/s10557-009-6189-0

    Article  CAS  PubMed  Google Scholar 

  49. Ypenburg C, van Erven L, Bleeker GB, Bax JJ, Bootsma M, Wijffels MC, van der Wall EE, Schalij MJ (2006) Benefit of combined resynchronization and defibrillator therapy in heart failure patients with and without ventricular arrhythmias. J Am Coll Cardiol 48(3):464–470

    Article  PubMed  Google Scholar 

  50. Bartalena L, Wiersinga WM, Tanda ML, Bogazzi F, Piantanida E, Lai A, Martino E (2004) Diagnosis and management of amiodarone-induced thyrotoxicosis in Europe: results of an international survey among members of the European Thyroid Association. Clin Endocrinol (Oxf) 61(4):494–502

    Article  Google Scholar 

  51. Lomenick JP, Jackson WA, Backeljauw PF (2004) Amiodarone-induced neonatal hypothyroidism: a unique form of transient early-onset hypothyroidism. J Perinatol 24(6):397–399. doi:10.1038/sj.jp.7211104 (pii: 7211104)

    Article  CAS  PubMed  Google Scholar 

  52. Bartalena L, Bogazzi F, Braverman LE, Martino E (2001) Effects of amiodarone administration during pregnancy on neonatal thyroid function and subsequent neurodevelopment. J Endocrinol Invest 24(2):116–130

    Article  CAS  PubMed  Google Scholar 

  53. Mackenzie C, Syed J, Pollak PT, Koren G (2011) Falling between the cracks: a case of amiodarone toxicity. CMAJ 183(12):1393–1397. doi:10.1503/cmaj.100351

    Article  PubMed Central  PubMed  Google Scholar 

Download references

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Third Department of Cardiology, Silesian Centre for Heart Disease, Medical University of Silesia, Curie-Sklodowska 9, 41-800, Zabrze, Poland

    Bartosz Hudzik

  2. Department of Nutrition-Associated Disease Prevention, Faculty of Public Health, Medical University of Silesia, Bytom, Poland

    Barbara Zubelewicz-Szkodzinska

  3. Department of Endocrinology, County Hospital, Piekary Slaskie, Poland

    Barbara Zubelewicz-Szkodzinska

Authors
  1. Bartosz Hudzik
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Barbara Zubelewicz-Szkodzinska
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Bartosz Hudzik.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hudzik, B., Zubelewicz-Szkodzinska, B. Amiodarone-related thyroid dysfunction. Intern Emerg Med 9, 829–839 (2014). https://doi.org/10.1007/s11739-014-1140-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11739-014-1140-1

Keywords

Search

Navigation