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Incidence and predictability of amiodarone-induced thyrotoxicosis and hypothyroidism

Inzidenz und Vorhersagbarkeit der Amiodaron-induzierten Schilddrüsenfunktionsstörungen

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Zusammenfassung

EINLEITUNG: Ziel dieser Studie war die Erfassung von Inzidenz und Prädiktabilität der Amiodaron-induzierten Hyperthyreose (AIT) und Hypothyreose (AIH) bei Patienten mit Kardiomyopathie. METHODEN: 72 Patienten (mittleres Alter 69 ± 11 Jahre) aus einem ehemaligen Jodmangelgebiet wurden hinsichtlich der Schilddrüsenfunktionsparameter vor, während und nach einer Amiodarontherapie untersucht. Alle Patienten wurden dabei zum ersten Mal mit Amiodaron behandelt. Der mediane Beobachtungszeitraum betrug 8 Monate bei 71 (98,6%) Patienten. ERGEBNISSE: Nur 18 von 72 Patienten (25,0%) hatten eine morphologisch unauffällige Schilddrüse. Die Prävalenz der Schilddrüsenfunktionsstörungen vor Amiodarontherapie betrug 37,6% (27 von 72) mit gleichem Verhältnis von Hypo- und Hyperthyreose (14 bzw. 13 Fälle). Eine Funktionsstörung nach Therapiebeginn wurde bei 56,8% (25 von 44) der Patienten ohne präexistente Schilddrüsenerkrankung diagnostiziert. Davon entwickelten 36,0% (9 von 25) der Patienten entweder eine subklinische oder klinisch manifeste AIH, 64,0% (16 von 25) eine subklinische oder manifeste AIT. Der Anteil der Patienten mit normaler Schilddrüsenfunktion sank von 61,1% (44 von 72) vor Therapiebeginn auf 26,7% (19 von 71, p < 0,001) unter Therapie. Die Entwicklung beider Funktionsstörungen war weder mit einer Schilddrüsenautoimmunerkrankung, dem 99mTc-Pertechnetat Uptake, höherem Lebensalter, Schilddrüsenautonomie noch einer abnormen Schilddrüsenmorphologie signifikant assoziiert. SCHLUSSFOLGERUNG: Es findet sich eine hohe Prävalenz von Schilddrüsenfunktionsstörungen bei älteren Patienten mit Kardiomyopathie, die mit Amiodaron behandelt werden. Über- oder Unterfunktion zeigten sich sowohl bei Patienten mit präexistenten Schilddrüsenfunktionsstörungen, als auch bei initial euthyreoten Patienten. Aufgrund der hohen Inzidenz von Schilddrüsenfunktionstörungen empfehlen sich regelmäßige Funktionskontrollen während und im Anschluss an eine Amiodarontherapie.

Summary

OBJECTIVES: To determine the incidence and predictability of amiodarone-induced thyrotoxicosis (AIT) and hypothyroidism (AIH) in patients with cardiomyopathy. PATIENTS AND METHODS: A total of 72 patients (mean age 69 ± 11 years) living in an area previously endemic for thyroid disease but with currently sufficient iodine intake were enrolled in this prospective study. All participants were treated with amiodarone for the first time. The course of thyroid function in patients with normal thyroid morphology and in those with goiter was monitored over a median follow-up period of eight months in 71 (98.6%) patients. RESULTS: Of 72 participants, 18 (25.0%) had a morphologically normal thyroid gland as evidenced by sonography. The prevalence of thyroid dysfunction before initiation of amiodarone was 37.6% (27 of 72) with almost equal distribution between hypothyroidism and hyperthyroidism (14 and 13 patients). After treatment with amiodarone, thyroid dysfunction was diagnosed in 56.8% (25 of 44) of the patients without preexisting dysfunction. Of these 25 patients, nine (36%) developed either subclinical or overt AIH and 16 (64.0%) developed either subclinical or overt AIT. Although 61.1% (44 of 72) had normal thyroid function before initiation of amiodarone, this number decreased to 26.7% (19 of 71, P < 0.001) after treatment. Factors such as 99mTc-pertechnetate scan uptake, thyroid autoimmunity, age, thyroid autonomy or abnormal thyroid morphology were not significantly associated with the development of thyroid dysfunction. CONCLUSIONS: Prevalence of thyroid dysfunction was high in elderly patients treated with amiodarone. Cases of AIT and AIH occurred in patients with and without preexisting thyroid disorders. Because of the high incidence of amiodarone-induced thyroid dysfunction, regular testing of thyroid function is mandatory during and following amiodarone treatment.

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Correspondence to Christian Pirich.

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Hofmann, A., Nawara, C., Ofluoglu, S. et al. Incidence and predictability of amiodarone-induced thyrotoxicosis and hypothyroidism. Wien Klin Wochenschr 120, 493–498 (2008). https://doi.org/10.1007/s00508-008-1017-2

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  • DOI: https://doi.org/10.1007/s00508-008-1017-2

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