Endocrine Abstracts

Introduction: Amiodarone induced thyrotoxicosis (AIT) occurs in 5–10% of patients and may occur at any time throughout the course of treatment including months after discontinuation. Two distinct forms of AIT are distinguished and treated differently. Iodine-induced hyperthyroidism, typically seen in patients with underlying thyroid disease, is referred to as typ1 AIT and treated with high doses of thionamide antithyroid drugs and perchlorate. Type 2 AIT is a destructive thyroiditis and most cases respond to high-dose glucocorticoids. However, mixed forms and refractory cases are occasionally observed and prolongued hyperthyroidism may lead to siginificant morbidity, especially in patients with significant cardiac comorbidities. Thyroidectomy rapidly restores normal thyroid function but must be performed in still overtly hyperthyroid often critically ill patients.

Methods: Retrospective analysis of the clinical records of all 12 patients with AIT, who underwent total thyroidectomy at the Department of Surgery, Kantonsspital St. Gallen, since 2006.

Results/cases: The age of the patients ranged from 50–81 years and 2 were female. All patients had an underlying structural cardiac disease and 8 had an ICD. All patients had been treated with thionamides, glucocorticoids or both for 3–10 weeks prior to surgery. Indications for total thyroidectomy included unresponsiveness to medical treatment and worsening of the underlying cardiac condition in several cases. Euthyroidism was restored quickly in all subjects. The length of the postoperative hospital stay ranged from 2–5 days and temporary intensive care was required in 3 patients. One patient died 3 weeks after surgery because of multiple preexisting complications. All other patients were euthyroid on levothyroxin replacement and in stable or improved cardiac condition for at least 1 year.

Conclusion: Total thyroidectomy is an effective and safe treatment in patients with AIT unresponsive to medical therapy and should be considered early to prevent subsequent cardiac morbidity due to prolongued overt hyperthyroidism.