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AMIODARONE AND THYROID DYSFUNCTION.

Filip Medić1, Miro Bakula2,3, Maša Alfirević4

  • 1Department of Obstetrics and Gynecology, Sveti Duh University Hospital, Zagreb, Croatia.

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Summary

Amiodarone, an antiarrhythmic drug, can cause thyroid dysfunction in 15-20% of patients. It may lead to amiodarone-induced hypothyroidism (AIH) or amiodarone-induced thyrotoxicosis (AIT), requiring regular monitoring and specific treatments.

Keywords:
AmiodaroneAmiodarone-induced hypothyroidismAmiodarone-induced thyrotoxicosisThyroid dysfunction

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Area of Science:

  • Endocrinology
  • Cardiology
  • Pharmacology

Background:

  • Thyroid hormones regulate bodily homeostasis, with thyroxine conversion to triiodothyronine influencing gene expression.
  • Amiodarone, a common antiarrhythmic, contains significant iodine, impacting thyroid function.
  • 15-20% of patients on amiodarone develop thyroid dysfunction, including amiodarone-induced hypothyroidism (AIH) and amiodarone-induced thyrotoxicosis (AIT).

Purpose of the Study:

  • To review the mechanisms, clinical presentations, and management of amiodarone-induced thyroid dysfunction.
  • To differentiate between types of AIT and AIH based on underlying thyroid status and iodine uptake.
  • To emphasize the importance of regular monitoring for thyroid abnormalities in patients treated with amiodarone.

Main Methods:

  • Literature review of amiodarone's effects on thyroid function.
  • Analysis of etiological factors contributing to AIH and AIT.
  • Summary of current treatment strategies for different types of amiodarone-induced thyroid dysfunction.

Main Results:

  • AIH is more prevalent in areas with sufficient iodine uptake and in patients with Hashimoto's thyroiditis.
  • AIT Type 1 occurs in patients with pre-existing thyroid conditions (e.g., goiter, Graves' disease) in iodine-deficient areas.
  • AIT Type 2 typically develops in individuals with previously healthy thyroids, linked to amiodarone's destructive effects and iodine load.

Conclusions:

  • Regular monitoring, including clinical and laboratory assessments, is crucial for early detection of thyroid dysfunction in amiodarone users.
  • AIH is managed with levothyroxine, often allowing continuation of amiodarone.
  • AIT Type 1 is treated with antithyroid drugs, while Type 2 responds to glucocorticoids, with amiodarone discontinuation considered when feasible.