Thyrotoxicosis associated with the use of amiodarone: the utility of ultrasound in patient management

Theodoraki, Aikaterini; Vanderpump, Mark

doi:10.1111/cen.12988

Cited by 22 publications

(29 citation statements)

References 31 publications

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“…Thus, RAIU has low diagnostic value in differentiating AIT 1 from AIT 2 in iodine-replete areas. The sensitivity for AIT 1 and specificity for AIT 2 from the available, albeit limited, data in studies with 99 TcO4 -and MIBI scintigraphy is low as the patient numbers studied so far are small [24,28,29]. This particularly applies to areas with iodine sufficiency.…”

Section: How Many Types Of Ait Can Be Identified and What Are The Diamentioning

confidence: 98%

“…Type 1 AIT (AIT 1) is a form of iodine-induced hyperthyroidism caused by excessive, uncontrolled biosynthesis of thyroid hormone by autonomously functioning thyroid tissue in response to iodine load, which typically develops in underlying nodular goitre or latent Graves disease [1,2,24]. Type 2 AIT (AIT 2) is a destructive thyroiditis occurring in an otherwise substantially normal thyroid gland [1,2,24].…”

Section: How Many Types Of Ait Can Be Identified and What Are The Diamentioning

confidence: 99%

“…Type 2 AIT (AIT 2) is a destructive thyroiditis occurring in an otherwise substantially normal thyroid gland [1,2,24]. A mixed/indefinite type is also recognized where patients acquire an overlapping condition of both types.…”

Section: How Many Types Of Ait Can Be Identified and What Are The Diamentioning

confidence: 99%

“…A mixed/indefinite type is also recognized where patients acquire an overlapping condition of both types. AIT 2 is more prevalent in iodine-sufficient areas [1,2,24] and, in general, is the most frequent form of AIT [25].…”

Section: How Many Types Of Ait Can Be Identified and What Are The Diamentioning

confidence: 99%

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2018 European Thyroid Association (ETA) Guidelines for the Management of Amiodarone-Associated Thyroid Dysfunction

Bartalena¹,

Bogazzi²,

Chiovato³

et al. 2018

Eur Thyroid J

195

184

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Treatment with amiodarone is associated with changes in thyroid function tests, but also with thyroid dysfunction (amiodarone-induced hypothyroidism, AIH, and amiodarone-induced thyrotoxicosis, AIT). Both AIH and AIT may develop in apparently normal thyroid glands or in the presence of underlying thyroid abnormalities. AIH does not require amiodarone withdrawal, and is treated with levothyroxine replacement if overt, whereas subclinical forms may be followed without treatment. Two main types of AIT are recognized: type 1 AIT (AIT 1), a form of iodine-induced hyperthyroidism occurring in nodular goitres or latent Graves disease, and type 2 AIT (AIT 2), resulting from destructive thyroiditis in a normal thyroid gland. Mixed/indefinite forms exist due to both pathogenic mechanisms. AIT 1 is best treated with thionamides that may be combined for a few weeks with sodium perchlorate to make the thyroid gland more sensitive to thionamides. AIT 2 is treated with oral glucocorticoids. Once euthyroidism has been restored, AIT 2 patients are followed up without treatment, whereas AIT 1 patients should be treated with thyroidectomy or radioiodine. Mixed/indefinite forms of AIT are treated with thionamides. Oral glucocorticoids can be added from the beginning if a precise diagnosis is uncertain, or after a few weeks if response to thionamides alone is poor. The decision to continue or to stop amiodarone in AIT should be individualized in relation to cardiovascular risk stratification and taken jointly by specialist cardiologists and endocrinologists. In the presence of rapidly deteriorating cardiac conditions, emergency thyroidectomy may be required for all forms of AIT.

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Section: How Many Types Of Ait Can Be Identified and What Are The Diamentioning

confidence: 98%

Section: How Many Types Of Ait Can Be Identified and What Are The Diamentioning

confidence: 99%

Section: How Many Types Of Ait Can Be Identified and What Are The Diamentioning

confidence: 99%

Section: How Many Types Of Ait Can Be Identified and What Are The Diamentioning

confidence: 99%

See 2 more Smart Citations

2018 European Thyroid Association (ETA) Guidelines for the Management of Amiodarone-Associated Thyroid Dysfunction

Bartalena¹,

Bogazzi²,

Chiovato³

et al. 2018

Eur Thyroid J

195

184

View full text Add to dashboard Cite

show abstract

“…Moreover, the analysis of nodular and extranodular blood flow was useful in the definition of the underlying thyroid diseases in type 1 AIT, being able to differentiate toxic multinodular goiter and toxic adenoma from Graves' disease [91]. This differentiation appeared to be of clinical relevance regarding therapeutic choice and outcome [94,95]. Separate evaluation of parenchymal blood flow from that of nodules may prove beneficial in the diagnosis of underlying thyroid diseases in patients with type 1 AIT [91].…”

Section: Conventional B-mode Ultrasoundmentioning

confidence: 99%

Thyroid Ultrasound: State of the Art Part 1 – Thyroid Ultrasound reporting and Diffuse Thyroid Diseases

et al. 2017

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Accurate differentiation of focal thyroid nodules (FTL) and thyroid abnormalities is pivotal for proper diagnostic and therapeutic work-up. In these two part articles, the role of ultrasound techniques in the characterization of FTL and evaluation of diffuse thyroid diseases is described to expand on the recently published World Federation in Ultrasound and Medicine (WFUMB) thyroid elastography guidelines and review how this guideline fits into a complete thyroid ultrasound exam.

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Mortality After Total Thyroidectomy for Amiodarone‐Induced Thyrotoxicosis According to Left Ventricular Ejection Fraction

Frey

Caillard

Mahot

et al. 2023

Otolaryngol.--head neck surg.

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ObjectiveTo report cardiac outcomes after total thyroidectomy for amiodarone‐induced thyrotoxicosis according to the baseline left ventricular ejection fraction in a tertiary referral center.Study DesignRetrospective, monocentric.SettingThe tertiary health care system.MethodsPatients who underwent total thyroidectomy for amiodarone‐induced thyrotoxicosis between 2010 and 2020 with age >18 and available preoperative left ventricular ejection fraction were included in this study. Patients were dichotomized into: group 1 with left ventricular ejection fraction ≥40% (mildly reduced/normal ejection fraction), and group 2 with left ventricular ejection fraction <40% (reduced ejection fraction).ResultsThere were 34 patients in group 1 and 17 to group 2. The latter were younger (median 58.4 [Q1‐Q3 48.0‐64.9] vs. 69.8 years in group 1 [59.8‐78.3], p = .0035) and they presented more cardiomyopathy (58.8 vs. 26.5%, p = .030). Overall, the median time until surgery referral was 3.1 [1.9‐7.1] months and 47.1% underwent surgery after restoration of euthyroidism. Surgical complications accounted for 7.8%. In group 2, the median left ventricular ejection fraction was significantly improved after surgery (22.5 [20.0‐25.0] vs. 29.0% [25.3‐45.5], p = .0078). Five‐year cardiac mortality was significantly higher in group 2 (p < .0001): 47.0% died of cardiac causes versus 2.9% in group 1. A baseline left ventricular ejection fraction <40% and a longer time until surgery referral were significantly associated with cardiac mortality (multivariable Cox regression analysis, p = .015 and .020, respectively).ConclusionThese results reinforce the idea that surgery, if chosen, should be performed quickly in patients with left ventricular ejection fraction <40%.

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Thyrotoxicosis associated with the use of amiodarone: the utility of ultrasound in patient management

Cited by 22 publications

References 31 publications

2018 European Thyroid Association (ETA) Guidelines for the Management of Amiodarone-Associated Thyroid Dysfunction

2018 European Thyroid Association (ETA) Guidelines for the Management of Amiodarone-Associated Thyroid Dysfunction

Thyroid Ultrasound: State of the Art Part 1 – Thyroid Ultrasound reporting and Diffuse Thyroid Diseases

Mortality After Total Thyroidectomy for Amiodarone‐Induced Thyrotoxicosis According to Left Ventricular Ejection Fraction

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