Endocrine Abstracts

Objective: To complete a retrospective clinical audit on the management of amiodarone-induced thyroid dysfunction in one centre using the existing European Thyroid Association 2018 guidelines, and to create a flowchart for clinical practice.

Methods: Patients were identified from thyroid clinic lists at University Hospital of Wales, Cardiff. 30 patients with amiodarone-induced thyroid dysfunction seen between 1st January 2023 and 1st May 2025 were identified. Clinical records were reviewed to study amiodarone use, investigations, diagnosis, and management plans. In addition, information was collected on treatment medications, length of treatment and whether emergency or definitive treatment was completed.

Results: Of the 30 patients, 22 were male and 8 were female. 18 were symptomatic on presentation, while 12 were found on thyroid monitoring. 26 (86.7%) patients were diagnosed with Amiodarone-Induced Thyrotoxicosis (AIT), compared to 4 (13.3%) with Amiodarone-Induced Hypothyroidism (AIH). 11 (42.3%) patients were confirmed to have AIT type 2, using colour-flow doppler sonography of the thyroid. Amiodarone was stopped in 22 (73.3%) of patients. All patients were discussed with cardiology. In general, 16 (61.5%) patients with AIT were treated with carbimazole, followed by 4 (15.4%) treated with carbimazole and steroids. Specifically, 8 patients (72.7%) with AIT type 2 were treated with carbimazole. AIH was managed with levothyroxine in 3 (75.0%) patients. No patients had emergency or definitive treatment.

Conclusions: Diagnosis of AIT into type 1, 2 or mixed was not consistently made prior to initiation of medical treatment. No patients were treated with glucocorticoids only, despite 11 being diagnosed with type 2 AIT. Generally, the department may need to proactively consider the need for emergency treatment in high-risk groups, such as the elderly or patients with reduced left ventricular function.