World Journal of Endocrine Surgery

Register      Login

VOLUME 9 , ISSUE 3 ( September-December, 2017 ) > List of Articles

ORIGINAL ARTICLE

Efficacy of the Surgical Management of Amiodarone-induced Thyrotoxicosis

Marilla Dickfos, Robert Franz

Citation Information : Dickfos M, Franz R. Efficacy of the Surgical Management of Amiodarone-induced Thyrotoxicosis. World J Endoc Surg 2017; 9 (3):79-87.

DOI: 10.5005/jp-journals-10002-1217

License: CC BY 3.0

Published Online: 01-06-2017

Copyright Statement:  Copyright © 2017; The Author(s).


Abstract

Introduction

Amiodarone can be a life-saving medication; however, it can also cause amiodarone-induced thyrotoxicosis (AIT). Though rare, AIT is a complex and life-threatening side effect, which can cause significant cardiac dysfunction and lead to cardiac failure. Primary treatment is with thionamides, perchlorates, and steroids. However, a small subgroup does not respond and their cardiovascular function continues to deteriorate. This select group is referred for a semi-elective total thyroidectomy. Without surgical removal of their thyroid gland, these patients will continue to deteriorate, with a 30 to 50% mortality rate for those not operated on.

Aim

The aim of this case series was to assess for any indicators as to when these patients should be referred for total thyroidectomies and the efficacy of this method of treatment.

Materials and methods

A case series of patients with AIT treated with a total thyroidectomy from 1998 to 2015 was used to assess the efficacy of and indicators for surgery.

Results

Total thyroidectomy results in efficient and significant improvement in the patient's biochemistry and symptoms. The patient's symptoms and options for medical therapy have an influence on the duration of the trial of medical therapy.

Conclusion

Surgery is an effective and efficient treatment for AIT. However, there does not appear to be a specific indicator for when this treatment should be instigated. A case-by-case approach should be adopted when treating these complicated patients.

Clinical significance

Clinicians should see surgery as an effective and efficient treatment for AIT. The timing of surgery should be assessed on a case-by-case basis considering the patient's clinical status and therapeutic options and not as a last resort.

How to cite this article

Dickfos M, Franz R. Efficacy of the Surgical Management of Amiodarone-induced Thyrotoxicosis. World J Endoc Surg 2017;9(3):79-87.


HTML PDF Share
  1. Diagnosis and management of amiodarone-induced thyrotoxicosis in Europe: results of an international survey among members of the European Thyroid Association. Clin Endocrinol (Oxf) 2004 Oct;61(4):494-502.
  2. Surgical management of Amiodarone-associated thyrotoxicosis: too risky or too effective? World J Surg 1998 Jun;22(6):537-543.
  3. Refractory amiodarone-associated thyrotoxicosis: an indication for thyroidectomy. Aust N Z J Surg 2000 Mar;70(3):174-178.
  4. Total thyroidectomy for amiodarone-associated thyrotoxicosis in patients with severe cardiac disease. World J Surg 2006 Nov;30(11):1957-1961.
  5. High prevalence of thyroid dysfunction in adult patients with beta-thalassemia major submitted to amiodarone treatment. J Endocrinol Invest 1999 Jan;22(1):55-63.
  6. Latrogenic thyrotoxicosis: causal circumstances, pathophysiology and principles of treatment — review of the literature. World J Surg 2000 Nov;24(11):1377-1385.
  7. Thyroidectomy for amiodarone-induced thyrotoxicosis. JAMA 1990 Mar;263(11):1526-1528.
  8. Surgery and anaesthesia for amiodarone-associated thyrotoxicosis. Aust N Z J Surg 2000 Mar;70(3):155-156.
  9. Clinical experience of amiodarone-induced thyrotoxicosis over a 3-year period: role of colour-flow Doppler sonography. Clin Endocrinol (Oxf) 2002 Jan;56(1):33-38.
  10. Total thyroidectomy for medically refractory amiodarone-induced thyrotoxicosis. Proc (Bayl Univ Med Cent) 2008 Oct;21(4): 382-385.
  11. Management of amiodarone-induced thyrotoxicosis. Swiss Med Wkly 2003 Nov;133(43-44):579-585.
  12. Total thyroidectomy in patients with amiodarone-induced thyrotoxicosis and severe left ventricular systolic dysfunction. J Clin Endocrinol Metab 2012 Oct;97(10):3515-3521.
  13. Amiodarone-induced thyrotoxicosis: a difficult diagnostic and therapeutic challenge. Clin Endo 2002 Jan;56(1):23-24.
  14. Drug-induced thyrotoxicosis: the surgical option. Isr Med Assoc J 2007 Feb;9(2):79-82.
  15. Surgical management of amiodarone-associated thyrotoxicosis: mayo clinic experience. World J Surg 2004 Nov;28(11):1083-1087.
  16. Amiodarone-induced thyrotoxicosis: is there a place for surgery? World J Surg 1993 Sep-Oct;17(5):622-627.
  17. Fatal outcome during anaesthesia induction in a patient with amiodarone-induced thyrotoxicosis. Eur J Anaesthesiol 2007 Oct;25:336-348.
  18. Total thyroidectomy for amiodarone-associated thyrotoxicosis: should surgery always be delayed for pre-operative medical preparation? J Laryngol Otol 2012 Jul;126(7):701-705.
  19. Surgical management of amiodarone-induced thyrotoxicosis. Otolaryngol Head Neck Surg 2003 Nov;129(5):565-570.
  20. Treatment of hyperthyroidism with a combination of methimazole and cholestyramine. J Clin Endocrinol Metab 1996 Sep;81(9):3191-3193.
  21. Endocrine and metabolic emergencies: thyroid storm. Ther Adv Endocrinol Metab 2010 Jun;1(3): 139-145.
  22. Factors influencing the echocardiographic estimate of right ventricular systolic pressure in normal patients and clinically relevant ranges according to age. Can J Cardiol 2010 Feb;26(2):e35-e39.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.