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[Amiodarone and thyroid: pharmacologic and toxic effects]

J Unger1

  • 1Service de Médecine Interne, Clinique César De Paepe 2000, Bruxelles.

Revue Medicale De Bruxelles
|September 1, 1996
PubMed
Summary

Amiodarone, an antiarrhythmic drug, can disrupt thyroid function, leading to either hypothyroidism or thyrotoxicosis. Regular thyroid-stimulating hormone (TSH) monitoring is crucial for managing these amiodarone-induced thyroid dysfunctions.

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Area of Science:

  • Endocrinology
  • Pharmacology
  • Thyroidology

Background:

  • Amiodarone is a potent antiarrhythmic medication with a complex pharmacokinetic profile.
  • Its structure contains a high iodine content, which can significantly impact thyroid hormone synthesis and metabolism.
  • Amiodarone is known to cause a spectrum of thyroidal and anti-thyroidal antibodies, leading to thyroid dysfunction.

Purpose of the Study:

  • To review the effects of amiodarone on thyroid function.
  • To outline the diagnostic criteria and management strategies for amiodarone-induced thyroid dysfunction.
  • To emphasize the importance of regular monitoring for thyroid-stimulating hormone (TSH) levels.

Main Methods:

  • Literature review of studies investigating amiodarone's effects on thyroid function.
  • Analysis of clinical data on amiodarone-induced hypothyroidism and thyrotoxicosis.
  • Summary of treatment protocols for managing thyroid dysfunction in patients taking amiodarone.

Main Results:

  • Amiodarone alters thyroid hormone levels, increasing free thyroxine (fT4) and decreasing free triiodothyronine (fT3).
  • It can transiently increase TSH, which may become undetectable, complicating diagnosis.
  • Amiodarone can induce both hypothyroidism (low fT4) and thyrotoxicosis (high total or free T3).

Conclusions:

  • Amiodarone-induced thyroid dysfunction requires careful diagnosis and management.
  • Hypothyroidism is treated with l-thyroxine, while thyrotoxicosis may necessitate medications like perchlorate, corticoids, plasmapheresis, or even thyroidectomy.
  • Regular TSH monitoring (twice yearly) is essential to exclude dysthyroidism in patients on amiodarone.

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