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The thyroid hormone (TH) plays a pivotal role in the intricate orchestration of physiological processes, exerting profound effects on development, metabolism, and homeostasis throughout different life stages.
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In pediatric care, understanding the nuances of hepatic drug metabolism is crucial, as it significantly differs from that of adults. This divergence is primarily due to the developmental stage of drug-metabolizing enzymes, which affects how medications are processed in the body. In neonates, for instance, the activity of Phase I enzymes—critical for the initial breakdown of drugs—is markedly reduced, functioning at just 20–40% of the levels seen in adults. This reduction poses...
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Amiodarone-induced thyroid dysfunction in children: insights from the THYRAMIO study.

Sarah Montenez1, Stéphane Moniotte2, Annie Robert3

  • 1Pediatric Endocrinology, Cliniques universitaires Saint Luc, Brussels, Belgium.

Therapeutic Advances in Endocrinology and Metabolism
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Summary

Nearly one in four children on amiodarone develop thyroid dysfunction. Older children receiving higher doses or prolonged treatment are at greater risk for amiodarone-induced thyrotoxicosis (AIT).

Keywords:
amiodaronearrhythmiachildthyroid

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Area of Science:

  • Pediatric Cardiology
  • Endocrinology
  • Pharmacology

Background:

  • Amiodarone is effective for arrhythmias but can cause thyroid dysfunction.
  • Pediatric amiodarone-induced thyroid dysfunction (AIHD) requires evaluation due to potential neurodevelopmental impacts.
  • This study defines AIHD incidence and risk factors in children.

Purpose of the Study:

  • To determine the incidence of amiodarone-induced thyroid dysfunction in pediatric patients.
  • To identify risk factors associated with amiodarone-induced hypothyroidism (AIH) and amiodarone-induced thyrotoxicosis (AIT).

Main Methods:

  • Observational study of 152 children treated with amiodarone (1990-2019).
  • Patients categorized into euthyroid, AIH, or AIT groups.
  • Clinical and therapeutic features compared across groups.

Main Results:

  • AIHD occurred in 23% of pediatric patients.
  • Amiodarone-induced hypothyroidism (AIH) was more common (17.7%) than amiodarone-induced thyrotoxicosis (AIT) (5.3%).
  • AIT risk increased with older age, higher dosage, longer duration, and more loading doses.

Conclusions:

  • One in five children experienced amiodarone-induced thyroid dysfunction.
  • Older children, high-dose, long-term amiodarone therapy, and multiple loading doses increase AIT risk.
  • AIT management is more complex than AIH, necessitating close monitoring in at-risk pediatric patients.