Surgical management of amiodarone-induced thyrotoxicosis

Franzese, Christine B.; Fan, Chris; Stack, Brendan C.

doi:10.1016/s0194-5998(03)01590-0

Cited by 24 publications

(14 citation statements)

References 6 publications

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“…However, this approach may be necessary in patients who are resistant to other treatments [65][66][67]. Recent studies have shown that total thyroidectomy can be performed in AIT patients without serious complications [68][69][70][71]. Pierret et al [72] performed 11 thyroidectomies in patients with AIT: 9 patients had no morbidity after elective surgery, while 2 patients required emergency surgery for multiple organ failure and cardiac problems.…”

Section: Total Thyroidectomymentioning

confidence: 99%

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Amiodaron i tarczyca

Jabrocka‐Hybel

Bednarczuk

Bartalena

et al. 2015

Endokrynologia Polska

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Amiodarone, a benzofuranic iodine-rich antiarrhythmic drug, causes thyroid dysfunction in 15-20% of cases. Amiodarone can cause both hypothyroidism (AIH, amiodarone-induced hypothyroidism) and thyrotoxicosis (AIT, amiodarone-induced thyrotoxicosis). AIH is treated by L-thyroxin replacement and does not need amiodarone discontinuation. There are two main forms of AIT: type 1, a form of true iodineinduced hyperthyroidism; and type 2, a drug-induced destructive thyroiditis. However, mixed/indefinite forms exist, contributed to by both pathogenic mechanisms. Type 1 AIT usually occurs in diseased thyroid glands, whereas type 2 AIT develops in substantially normal thyroid glands. Thioamides represent the first-line treatment for type 1 AIT, but iodine-replete glands are poorly responsive; sodium/ /potassium perchlorate, by inhibiting thyroidal iodine uptake, may increase the response to thioamides. Type 2 AIT is best treated by oral glucocorticoids. Response depends on thyroid volume and severity of thyrotoxicosis. Mixed/indefinite forms may require a combination of thioamides, potassium perchlorate, and steroids. Radioiodine treatment is usually not feasible because amiodarone-related iodine load decreases thyroidal radioiodine uptake. Thyroidectomy represents an important and helpful option in cases resistant to medical therapy. Surgery performed by a skilled surgeon may represent an emergent treatment in patients who have severe cardiac dysfunction. StreszczenieLek antyarytmiczny -amiodaron, pochodna benzofuranu bogata w jod, wywołuje zaburzenia funkcji tarczycy w 15-20% przypadków. Amiodaron może powodować niedoczynność tarczycy (AIH) oraz nadczynność tarczycy (AIT). AIH jest leczona substytucyjnie lewotyroksyną, w jej przypadku nie jest konieczne odstawienie amiodaronu. Nadczynność tarczycy indukowaną amiodaronem dzielimy na dwa typy: typ 1 -nadczynność tarczycy związana z nadmierną produkcją hormonów tarczycowych, oraz typ 2, w której dominuje proces zapalenia tarczycy związanego z rozpadem gruczołu. Wyróżnia się również typ mieszany/nieokreślony, w którego patomechanizmie udział biorą oba powyżej opisane mechanizmy. Typ 1 AIT występuje zwykle na podłożu wcześniej występującej choroby tarczycy, zaś typ 2 w pierwotnie zdrowym gruczole tarczowym. Tionamidy są lekiem pierwszego rzutu w leczeniu typu 1 AIT, nadchloran sodowy/ /potasowy poprzez hamowanie wychwytu jodu może zwiększać odpowiedź na tionamidy. AIT typu 2 jest leczone głównie z zastosowaniem glikokortykosteroidów. Odpowiedź na leczenie zależy od wielkości gruczołu tarczowego i ciężkości tyreotoksykozy. Postaci mieszane mogą wymagać zastosowania złożonej terapii z użyciem tionamidów, nadchloranu sodowego/potasowego oraz steroidów. Leczenie radiojodem często jest niemożliwe z powodu zmniejszonego wychwytu jodu u pacjentów wcześniej leczonych amiodaronem. Zabieg usunięcia tarczycy jest bardzo pomocną formą leczenia nadczynności tarczycy indukowanej jodem, szczególnie w przypadkach opornych na leczenie farmakologiczne. Tyroidektomia wykonana przez do...

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Section: Total Thyroidectomymentioning

confidence: 99%

“…Jednak postępowanie to może okazać się konieczne u pacjentów opornych na inne sposoby leczenia [65][66][67]. Ostatnie badania wykazały, że cał-kowite wycięcie tarczycy może być przeprowadzone u pacjentów z AIT bez poważnych powikłań [68][69][70][71]. Pierret i wsp.…”

Section: Typ 1 Aitunclassified

Amiodaron i tarczyca

Jabrocka‐Hybel

Bednarczuk

Bartalena

et al. 2015

Endokrynologia Polska

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“…In contrast with type 2 AIT, definitive treatment of the underlying thyroid disease is generally needed after restoration of euthyroidism and removal of iodine load. This can be achieved with radioiodine therapy (usually after several months, because of persistent iodine contamination) or with total thyroidectomy, possibly after a short preparation with iopanoic acid 11–13 . However, it should be noted that iopanoic acid might not be easily available in other countries like the USA.…”

Section: Introductionmentioning

confidence: 99%

Proportion of type 1 and type 2 amiodarone‐induced thyrotoxicosis has changed over a 27‐year period in Italy

Bogazzi

Bartalena

Dell'Unto

et al. 2007

Clinical Endocrinology

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Over a 27-year period, the epidemiology of AIT changed, as the prevalence of type 2 AIT progressively increased and that of type 1 remained constant. Thus, under most circumstances, endocrinologists nowadays deal with type 2 AIT, which is a destructive thyroiditis, generally treated successfully with glucocorticoids. Although no additional treatment is usually required after the destructive process subsides, periodic assessment of thyroid function is warranted, because of the occurrence of hypothyroidism (up to 17%) during long-term follow-up of these patients.

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“…One would think whether this has implications for avoiding recurrent laryngeal nerve injury during thyroidectomy. According to some authors, a lower rate of this nerve injury could be attributable to conversation with the patient, being a type of monitoring . Nine patients (4 per cent) in the GA group and one patient (2 per cent) in the LA group had vocal cord palsy, but the difference was not statistically significant ( P = 0.512).…”

Section: Discussionmentioning

confidence: 94%

Hemithyroidectomy using local or general anaesthesia: Results of a local regional hospital

et al. 2017

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Aim Thyroidectomy is commonly performed for benign and malignant diseases of the thyroid gland. We report our results of performing hemithyroidectomy under local anaesthesia (LA) or general anaesthesia (GA) in a local tertiary hospital. Patients and Methods Patients’ demographic data, operative time, length of hospital stay and complications were recorded. Multiple regression analyses were used to assess the risk‐adjusted endpoints. The mean follow up was 12.6 months. Results From January 2010 to December 2014, 279 patients underwent hemithyroidectomy, of which 229 (82 per cent) were under GA. The mean age was 50.0 ± 14.6 years, and 238 (85 per cent) patients were female. In the univariate analysis, GA was associated with a longer operative time (99.3 vs 75.4 min, P = 0.011) and a longer hospital day (2.3 vs 1.4 days, P < 0.001). After adjusting for other covariates with multiple regression analyses, GA was still associated with a longer operative time by 16.1 min (P = 0.006) and a longer hospital stay by 1.15 days (P < 0.001). It had a higher complication rate (odds ratio = 3.26, P = 0.181), albeit not statistically significant. Conclusions Hemithyroidectomy under LA is associated with a shorter operative time and hospital stay, and is a safe and viable alternative to GA in selected patients.

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Surgical management of amiodarone-induced thyrotoxicosis

Cited by 24 publications

References 6 publications

Amiodaron i tarczyca

Amiodaron i tarczyca

Proportion of type 1 and type 2 amiodarone‐induced thyrotoxicosis has changed over a 27‐year period in Italy

Hemithyroidectomy using local or general anaesthesia: Results of a local regional hospital

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