| Continuation of Amiodarone Delays Restoration of Euthyroidism in Patients with Type 2 Amiodarone-Induced Thyrotoxicosis Treated with Prednisone: A Pilot Study. | |
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MedLine Citation:
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PMID: 21865355 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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Context: Type 2 amiodarone-induced thyrotoxicosis (AIT) is a destructive thyroiditis usually responsive to glucocorticoids. Whether continuation of amiodarone affects treatment outcome is unsettled. Objective: The objective of the study was to compare the outcome of glucocorticoid treatment in type 2 AIT patients who continued or withdrew amiodarone. Design: This was a matched retrospective cohort study. Setting: The study was conducted at a university center. Patients: Eighty-three consecutive patients with untreated type 2 AIT participated in the study. After matching with patients continuing amiodarone (AMIO-ON, n = 8), patients interrupting amiodarone were randomly selected in a 4:1 ratio (AMIO-OFF, n = 32). Intervention: All patients were treated with oral prednisone. Patients whose thyrotoxicosis recurred after glucocorticoid withdrawal were treated with a second course of prednisone. Main Outcome Measure: Time and rate of cure were measured. Results: Median time to the first normalization of serum thyroid hormone levels did not significantly differ in AMIO-ON and AMIO-OFF patients (24 and 31 d, respectively; P = 0.326). Conversely, median time for stably restoring euthyroidism was 140 d in AMIO-ON patients and 47 d in AMIO-OFF patients (log rank, P = 0.011). In fact, AIT recurred in five of seven AMIO-ON patients (71.4%) and in only three of 32 AMIO-OFF patients (9.4%, P = 0.002), requiring readministration of prednisone. One AMIO-ON patient never reached thyroid hormone normalization during the study period. Factors associated with glucocorticoid failure were thyroid volume and amiodarone continuation. Conclusions: Prednisone restores euthyroidism in most type 2 AIT patients, irrespective of amiodarone continuation or withdrawal. However, continuing amiodarone increases the recurrence rate of thyrotoxicosis, causing a delay in the stable restoration of euthyroidism and a longer exposure of the heart to thyroid hormone excess. |
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Authors:
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Fausto Bogazzi; Luigi Bartalena; Luca Tomisti; Giuseppe Rossi; Sandra Brogioni; Enio Martino |
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Publication Detail:
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Type: JOURNAL ARTICLE Date: 2011-8-24 |
Journal Detail:
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Title: The Journal of clinical endocrinology and metabolism Volume: - ISSN: 1945-7197 ISO Abbreviation: - Publication Date: 2011 Aug |
Date Detail:
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Created Date: 2011-8-25 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0375362 Medline TA: J Clin Endocrinol Metab Country: - |
Other Details:
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Languages: ENG Pagination: - Citation Subset: - |
Affiliation:
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Department of Endocrinology and Metabolism (F.B., L.T., S.B., E.M.), University of Pisa, 56124, Pisa, Italy; Department of Clinical Medicine (L.B.), University of Insubria, 21100 Varese, Italy; and Unit of Epidemiology and Biostatistics, Institute of Clinical Physiology, National Research Council and G. Monasterio Foundation (G.R.), 56100 Pisa, Italy. |
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