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Colegio de Medicina Interna de México.

2011, Number 3

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Med Int Mex 2011; 27 (3)

Thyroid dysfunction induced by amiodarone. Analysis in terms of clinical practice

Casuso E, Nan D, Hernández JL, García RO, Alonso J, González-Macías J

Language: Spanish
References: 22
Page: 231-237
PDF size: 326.74 Kb.


ABSTRACT

Background: Thyroid dysfunction has been associated with the use of amiodarone.
Objective: analyse the epidemiological features and to describe the clinical management of patients with amiodarone-induced thyroid dysfunction in everyday practice.
Material and Methods: Two-year retrospective descriptive study of patients with alterations in thyroid hormone levels after treatment with amiodarone.
Results: A total of 1626 patients started on amiodarone and in 61% of them no hormonal control was requested. Of the remaining 627 patients, any thyroid dysfunction was detected in 155 (24.7%), 89 men and 66 women. The most frequent thyroid alteration was hypothyroidism (9.7%), followed by hyperthyroidism (8.1%). There were 31 subclinical thyroid dysfunctions (4.9%). Atrial fibrillation was the most frequent arrhythmia (92 %) that prompted the initiation of the antiarrhythmic agent, and the most frequent underlying cardiac disease was hypertensive cardiomyopathy (54%). Thirty-five percent of patients had typical symptoms of thyroid dysfunction. Anti-thyroid antibodies were requested in 56 patients (36%) and they were positive in 13 (23%). In 81 cases (64%), thyroid dysfunction prompted the clinician to withdraw amiodarone, and 40% of them did receive specific treatment. Fifty-four patients (35%) recovered normal thyroid function, whereas 17% remained hyper o hypothyroid. One patient died from myxedema coma.
Conclusions: Clinicians did not request serum thyroid hormone levels in a high proportion of patients on amiodarone. Although mortality due to these disorders used to be low, they can carry out an important morbidity in patients with a previous cardiomyopathy. Thus, monitoring thyroid function when on amiodarone is strongly recommended.


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