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[Value of total thyroidectomy in amiodarone-induced hyperthyroidism]
M P Dariel1, S Hervé, O Chollet
1Service d'ORL et de CCF, Service de Médecine Aéronautique, Hôpital d'Instruction des Armées Percy. 101, Avenue Henri Barbusse. BP 406, 92141 Clamart Cedex.
Insights
Amiodarone can cause severe hyperthyroidism, especially in heart patients. Thyroidectomy surgery is a radical option when medical treatments fail and amiodarone is essential.
Area of Science:
- Cardiology
- Endocrinology
- Thyroidology
Background:
- Amiodarone is a critical medication for managing cardiac arrhythmias.
- Amiodarone-induced hyperthyroidism (AIH) poses a significant risk, particularly in patients with severe cardiopathy.
- Standard medical treatments for AIH, including antithyroid drugs, steroids, and potassium perchlorate, can be ineffective.
Observation:
- The authors present a case of a patient with right ventricle arrhythmogenic dysplasia who developed severe hyperthyroidism 3 years after initiating amiodarone therapy.
- The patient had no prior history of thyroid disease.
- Medical management for hyperthyroidism failed to resolve the condition.
Findings:
- Total thyroidectomy was performed as a last resort after medical treatments proved ineffective.
- The surgical intervention rapidly resolved the hyperthyroidism.
- Following thyroidectomy, amiodarone therapy could be safely reintroduced, indicating its necessity for managing the patient's cardiac condition.
Implications:
- Thyroidectomy represents a viable and potentially curative treatment for severe amiodarone-induced hyperthyroidism when medical management fails.
- This approach is particularly crucial for patients with severe cardiopathy who require ongoing amiodarone therapy.
- Early consideration of surgical intervention may prevent prolonged or irreversible cardiac complications associated with uncontrolled AIH.
Abstract:
The potential severity of amiodarone-induced hyperthyroidism, particularly in severe cardiopathy cases, necessitates a regular clinic and biologic thyroid control. The break in amiodarone and a medical treatment (synthetic antithyroid drugs, steroids, perchlorate of potassium) can be ineffective. The authors report the case of a patient with an right ventricle arythmogenic dysplasia, without thyroid history, who came back 3 years after the introducing of amiodarone with major hyperthyroidism. After failure of medical treatment, a total thyroidectomy permitted to quickly stop hyperthyroidism and to early reintroduce amiodarone. Surgery seems to be the radical treatment when hyperthyroidism doesn't respond to the medical treatment and when the cardiopathy requires amiodarone.