Amiodarone-Induced Thyrotoxicosis in Adults with Congenital Heart Disease -Clinical Presentation and Response to Therapy |
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| Affiliation: | 1. Department of Internal Medicine, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, Minnesota;2. Department of Endocrinology, Central DuPage Hospital, Winfield, Illinois;3. Department of Internal Medicine, Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota;4. Department of Health Sciences Research, Division of Biostatistics, Mayo Clinic, Rochester, Minnesota.;1. Department of Otolaryngology, Head, and Neck Surgery;2. Department of Endocrinology;3. Department of Pathology, Thomas Jefferson University, Philadelphia, Pennsylvania.;1. Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg‐University Mainz, Mainz, Germany;2. German Center for Cardiovascular Research (DZHK), Partner Site Rhine‐Main, Mainz, Germany;3. Center for Thrombosis and Hemostasis, University Medical Center Mainz, Johannes Gutenberg University Mainz, Mainz, Germany;4. Department of Medicine II, University Medical Center of the Johannes Gutenberg‐University Mainz, Mainz, Germany;5. Preventive Cardiology and Preventive Medicine, Department of Medicine II, University Medical Center of the Johannes Gutenberg‐University Mainz, Mainz, Germany;1. Department of Endocrinology and Metabolism, Faculty of Medicine, Çanakkale Onsekiz Mart University, Çanakkale, Turkey;2. Department of Cardiology, Bergama Government Hospital, Izmir, Turkey;3. Department of Cardiology, Faculty of Medicine, Çanakkale Onsekiz Mart University, Çanakkale, Turkey;4. Department of Endocrinology and Metabolism, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey;5. Department of General Surgery, Faculty of Medicine, Çanakkale Onsekiz Mart University, Çanakkale, Turkey;6. Department of General Medicine, Faculty of Medicine, Çanakkale Onsekiz Mart University, Çanakkale, Turkey;7. Department of Endocrinology and Metabolism, Faculty of Medicine, Ankara University, Ankara, Turkey.;1. Department of Internal Medicine, Division of Endocrinology, John Stroger Hospital of Cook County, Chicago, Illinois;2. Rush University Medical Center, Chicago, Illinois;3. Department of Cell Biology, Physiology, and Immunology, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC)/Hospital Universitario Reina Sofia, University of Cordoba and CIBER de la Fisiopatología de la Obesidad y Nutrición (CIBERobn), Córdoba, Spain;4. Neurosurgery and Anatomy and Cell Biology, Rush University, University of Illinois at Chicago, Illinois;5. Department of Pathology, John Stroger Hospital of Cook County, Chicago, Illinois. |
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| Abstract: | ObjectiveThe development of amiodarone-induced thyrotoxicosis (AIT) can threaten the hemodynamic stability of adult patients with congenital heart disease (CHD). Here, we describe the natural history and treatment response of AIT in this at-risk population.MethodsWe studied retrospectively all cases of AIT that occurred in CHD patients at our institution after a minimum of 3 months on amiodarone. Subjects were identified from the cohort of adults with CHD who were treated at the Mayo Clinic Adult CHD clinic between 1987 and 2009.ResultsWe identified 23 cases of AIT: 7 were type 1, 13 were type 2, and 3 were undefined due to insufficient data. Most patients were symptomatic (17 of 23, 74%), with arrhythmia and weight loss as the most common symptoms. The majority (12 of 23, 52%) were initially observed; 10 patients (43%) were treated medically and 1 patient (5%) underwent thyroidectomy. Four patients from the observation group eventually required active treatment and 3 patients from the medical group required surgery. Asymptomatic patients tended to resolve under observation (5 of 7, 71.4%) rather than progress to active treatment (0 of 4) (P = .06). Discontinuation of amiodarone, AIT type, or use of perchlorate did not impact AIT duration.ConclusionAIT in CHD patients exhibits a wide range of severity and sensitivity to medical therapy. Asymptomatic patients display a trend toward AIT resolution with observation alone. Amiodarone continuation does not appear to impact management outcome or disease duration. Additional studies in this high-risk population could identify elements of pathophysiology that would point toward better disease prevention and treatment. (Endocr Pract. 2014;20:33-40) |
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