[Indications for subtotal thyroidectomy in patients with amiodarone- (iodine-) induced hyperthyroidism]

Therapy with the antiarrhythmic drug amiodarone implies administration of free iodine in dosages between 6 and 36 mg/day. Especially patients from areas with low iodine intake are at risk to develop iodine-related hyperthyroidism. In 2 case reports the indication of subtotal thyroidectomy is discussed. In 1 patient decision for operation was made after 7 weeks of inefficient therapy with high-dose methimazole. For another patient decision for operation was made but performance had to be postponed because of acute myocardial infarction. Surgical therapy has the advantage of immediate and safe effectivity, low risk of relapse and provides the possibility of further iodine administration without major problems. The risk of operation has to be evaluated against the risk of a long-term treatment with antithyroid drugs preferentially from the thiomide type or against the risk of persistent hyperthyroidism.