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Goitre and thyroid dysfunction during chronic amiodarone treatment.

R J Eason, M S Croxson, T M Lim

    The New Zealand Medical Journal
    |April 11, 1984
    PubMed
    Summary
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    Amiodarone treatment can cause thyroid dysfunction, including goiter and altered thyroid hormone levels, even in clinically euthyroid patients. This study highlights the unpredictable thyroid response to amiodarone and excess iodide.

    Area of Science:

    • Endocrinology
    • Pharmacology
    • Internal Medicine

    Background:

    • Amiodarone is an effective antiarrhythmic drug.
    • Amiodarone contains a high iodine content, which can affect thyroid function.
    • Thyroid dysfunction is a known complication of amiodarone therapy.

    Purpose of the Study:

    • To investigate thyroid function in patients on chronic amiodarone treatment.
    • To characterize the spectrum of thyroid dysfunction associated with amiodarone.
    • To explore the relationship between amiodarone, iodide levels, and thyroid function.

    Main Methods:

    • Cross-sectional survey of 37 unselected patients on chronic amiodarone.
    • Measurement of serum free T4, free T4 index, free T3, free T3 index, and TSH.

    Related Experiment Videos

  • Assessment of TRH response and urine iodide/creatinine excretion.

    • Main Results:

    • 17 patients (46%) had palpable goiter; 10 were new findings.
    • 67% had elevated serum free T4; 43% had elevated free T4 index.
    • All patients were clinically euthyroid with normal or decreased free T3 or free T3 index.
    • Mean urine iodide/creatinine excretion was 13-fold higher than normal.
    • Three patterns of thyroid function observed: elevated TSH with normal TRH response (n=21), biochemical hypothyroidism (n=5), and thyroid autonomy (n=11).
    • Three patients with absent TRH response had a history of goiter/thyrotoxicosis; carbimazole was ineffective.

    Conclusions:

    • Amiodarone treatment is associated with a spectrum of thyroid dysfunction, including goiter and altered thyroid hormone levels.
    • Excessive iodide from amiodarone, combined with a weak goitrogenic effect, likely contributes to thyroid dysfunction.
    • Clinical monitoring for thyroid abnormalities is crucial in patients receiving chronic amiodarone therapy.