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Amiodarone-Induced Thyroid Dysfunction

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The Thyroid and Its Diseases

Abstract

Amiodarone is an antiarrhythmic drug, containing 37% iodine by weight, and with structural similarities to thyroid hormones. Amiodarone-induced thyroid dysfunction occurs in 15–20% of patients and includes amiodarone-induced hypothyroidism (AIH) and amiodarone-induced thyrotoxicosis (AIT). AIH is due to failure to escape from the acute Wolff-Chaikoff effect and is easily treated with levothyroxine replacement without requiring amiodarone withdrawal. There are two types of AIT: type 1 AIT, a form of iodine-induced thyrotoxicosis that develops in patients with underlying thyroid disease exposed to the high iodine content of amiodarone, and type 2 AIT, a drug-induced destructive thyroiditis caused by a direct cytotoxic effect of amiodarone. In some cases both pathogeneses coexist and these forms are called mixed forms. Differential diagnosis between AIT types is important since therapy differs. Type 1 AIT is treated with thionamide and in some cases by adding potassium perchlorate; type 2 AIT is treated with glucocorticoids; mixed forms may benefit from the combination of thionamide and glucocorticoids. Patients who are resistant to the other forms of treatment or who need a rapid restoration of euthyroidism should be treated by thyroidectomy. Radioactive iodine is usually not feasible, since these patients have a low radioiodine uptake. Monitoring of thyroid function should be performed before starting amiodarone and then every 3 months during amiodarone therapy and up to at least 2 years after amiodarone withdrawal.

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Authors and Affiliations

  1. Endocrine Unit, Fondazione IRCCS Cà Granda, Milan, Italy

    Simone De Leo

  2. Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy

    Simone De Leo

  3. Section of Endocrinology, Diabetes and Nutrition, Boston University School of Medicine, Boston, MA, USA

    Simone De Leo & Lewis E. Braverman

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  1. Simone De Leo
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  2. Lewis E. Braverman
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Correspondence to Lewis E. Braverman .

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Editors and Affiliations

  1. Department of Nuclear Medicine, Philipps University Marburg, Marburg, Germany

    Markus Luster

  2. Unit of Endocrinology Diabetes and Metabolism, Evgenidion Hospital, National and Kapodistrian University of Athens, Athens, Greece

    Leonidas H. Duntas

  3. Georgetown University School of Medicine, Washington, DC, USA

    Leonard Wartofsky

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De Leo, S., Braverman, L.E. (2019). Amiodarone-Induced Thyroid Dysfunction. In: Luster, M., Duntas, L., Wartofsky, L. (eds) The Thyroid and Its Diseases. Springer, Cham. https://doi.org/10.1007/978-3-319-72102-6_30

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