Document Detail

Amiodarone-induced thyrotoxicosis in a patient with autonomously functioning nodular goiter.
MedLine Citation:
PMID:  19109209     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To report on adverse reactions associated with amiodarone and propylthiouracil. CASE SUMMARY: A 64-year-old female with atrial fibrillation and nodular goiter progressed to overt thyrotoxicosis after receiving therapy with amiodarone 200 mg/day for less than 12 weeks. Thyroid scan revealed a hyperfunctioning nodule in the left lobe, while immunologic studies were negative for both thyroid peroxidase and thyroglobulin antibodies. The thyroid-stimulating hormone (TSH) receptor antibody level was transiently elevated. Propylthiouracil 100 mg 3 times/day was started after the withdrawal of amiodarone, but the patient developed severe generalized skin rash, fever, and leukocytosis after 4 weeks. Thyroidectomy was performed, and histopathology was compatible with type 1 amiodarone-induced thyrotoxicosis (AIT) associated with toxic nodular goiter. An objective causality assessment revealed that thyrotoxicosis was probably related to use of amiodarone. DISCUSSION: Amiodarone is an antiarrhythmic agent that may cause thyroid dysfunction. Differentiating between the 2 types of AIT is important for implementation of the correct therapeutic strategy. The transient elevation of TSH receptor antibodies in AIT complicated the diagnosis. As a rare subtype, type 1 AIT by nodular goiter may be associated with early AIT. Initiating thyroid function monitoring within 3 months of amiodarone therapy should be considered. CONCLUSIONS: Type 1 AIT caused by nodular goiter is rarely reported. Amiodarone should be avoided in such patients and subtotal thyroidectomy to remove the toxic nodule may be the treatment of choice.
Yi-Lin Liang; Shih-Ming Huang; Shu-Ling Peng; Shu-Hwa Hsiao; Hao-Chang Hung; Horng-Yih Ou; Ta-Jen Wu
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Publication Detail:
Type:  Case Reports; Journal Article     Date:  2008-12-23
Journal Detail:
Title:  The Annals of pharmacotherapy     Volume:  43     ISSN:  1542-6270     ISO Abbreviation:  Ann Pharmacother     Publication Date:  2009 Jan 
Date Detail:
Created Date:  2009-05-01     Completed Date:  2010-01-04     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9203131     Medline TA:  Ann Pharmacother     Country:  United States    
Other Details:
Languages:  eng     Pagination:  134-8     Citation Subset:  IM    
Department of Internal Medicine, National Cheng Kung University Hospital, Taiwan, Republic of China.
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MeSH Terms
Amiodarone / adverse effects*
Anti-Arrhythmia Agents / adverse effects*
Goiter, Nodular* / complications,  diagnosis
Middle Aged
Thyrotoxicosis / chemically induced*,  diagnosis,  physiopathology
Reg. No./Substance:
0/Anti-Arrhythmia Agents; 1951-25-3/Amiodarone

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