Patterns of amiodarone-induced thyroid dysfunction in infants and children

Area of Science:

• Pediatric Endocrinology
• Cardiology
• Pharmacology

Background:

• Current guidelines lack specific pediatric recommendations for thyroid function tests (TFTs) during amiodarone therapy.
• Untreated hypothyroidism in children can impair brain development and growth.
• Limited data exist on amiodarone-induced thyroid dysfunction in pediatric populations.

Purpose of the Study:

• To describe the patterns and prevalence of amiodarone-induced thyroid dysfunction in pediatric patients.

Main Methods:

• Retrospective cohort study of 527 pediatric patients treated with amiodarone between 1997 and 2017.
• Defined "short term" amiodarone therapy as 3-30 days and "long term" as >30 days.
• Analyzed thyroid-stimulating hormone (TSH) levels in a final cohort of 150 patients.

Main Results:

• Half of the pediatric patients (50.8%) showed elevated TSH levels.
• Neonates and infants experienced higher median peak TSH values compared to older children, even with short-term amiodarone exposure.
• No cardiac illness variables were associated with peak TSH levels, though inotropic support correlated with lower initial TSH.

Conclusions:

• Neonates and infants are at higher risk for amiodarone-induced thyroid dysfunction with significant TSH elevations.
• Thyroid dysfunction can manifest early, even with short-term amiodarone use.
• Results support the need for tailored pediatric-specific thyroid monitoring guidelines for amiodarone therapy.