ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Endocrine Abstracts (2008) 16 P726

Surgical management of amiodarone-associated thyrotoxicosis

Silvia Maraver, Isabel Serrano, Cristobal Morales, Guillermo Martínez de Pinillos, Juan Manuel Garcia-Quiros, Monica Tome, Antonio Jimenez-Garcia & Angel Sendon


Virgen Macarena Hospital, Seville, Spain.


Introduction: Amiodarone is an excellent antiarrhythmic with a high use although it isn’t free from complications. Most of patients stay euthyroid (80%), inducing thyroid dysfunction in the remaining 20% (thyrotoxicosis, 1.5–3%).

Objective: We analyze amiodarona-associated hyperthyroidism surgical management according to the associated pathology and patients clinical evolution.

Subjects and methods: We report four patients with amiodarona-associated hyperthyroidism occurred between September 05 and March 07, two women and two men from 44 to 74.

Patient 1: chronic bronchitis, paroxysmal atrial fibrillation (PAF). Treatment: antithyroids and corticosteroids. Toxic hepatitis induced by metimazol. 1 month of hyperthyroidism. T4L 6.1 ng/dl. Patient 2: Arterial hypertension, FAP. Treatment: antithyroids and corticosteroids. Four months of hyperthyroidism. T4L 7.5. Patient 3: HIV, chronic hepatitis, chronic renal failure, arterial hypertension, moderate aortic stenosis, PAF. Treatment: antithyroid and corticosteroids. Two months of hyperthyroidism. T4L 6.5. Patient 4: vascular encephalopathy, heart failure (double mitral valve, tricuspid failure valve, pulmonary hypertension), PAF. Treatment: antithyroids, corticoids and potassium perchlorate. Two months of hyperthyroidism. T4L 7.7.

Results: Patient 1: thyroidectomy without peri-postoperative complications. Median hospital stay 2 days. TSH 0.1 mcU/ml and T4L 1.7 ng/dl. Patient 2: thyroidectomy without peri-postoperative complications. Median hospital stay 2 days. TSH 0.1. T4L 1.6. Patient 3: not surgical indication (severe plaquetopenia). TSH 4.3. T4L 1.5. Patient 4: not surgical indication (comorbidities). TSH 5.8. T4L 1.1.

Conclusions:
1. Although comorbidities involve a high cardiovascular surgery risk, total thyroidectomy doesn’t mean more difficulties and a higher rate of complications shouldn’t be expected.

2. Surgical treatment arises when it is not possible to discontinue treatment with amiodarone, when complications appears from the use of antithyroids and when is necessary an early symptomatic control.

3. There is a need for an assessment of each patient in order to establish a safer therapeutic approach.

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