Amiodarone-induced thyrotoxicosis: a modern view of the problem

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Abstract

The review article discusses the main problematic issues of the epidemiology, etiology, and pathogenesis of amiodarone-induced thyrotoxicosis (AmIT). The effect of iodine on the thyroid gland (TG) is described in detail. Particular attention is paid to the pathogenetic aspects of the development of this type of thyrotoxicosis. Issues of «type specificity» of thyroid dysfunction caused by amiodarone are discussed. The complex issues of differential diagnosis of the 1st and 2nd types of AmIT are considered. The problem of identifying the so-called mixed type is discussed. Various innovative approaches to therapy including first-line agents with or without consideration for the pathogenetic AmIT type are compared. The indications for radical treatment of this type of thyrotoxicosis are specified. The issues of cancellation and re-appointment of amiodarone and the algorithm of actions in this type of thyropathies are discussed.

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About the authors

Vladimir V. Salukhov

S.M. Kirov Military Medical Academy

Author for correspondence.
Email: vlasaluk@yandex.ru
ORCID iD: 0000-0003-1851-0941

Dr. Sci. (Med.), Associate Professor, Head of the 1st Department (Therapy for Advanced Medical Training), S.M.Kirov Military Medical Academy., St. Petersburg, Russia

Russian Federation, St. Petersburg

E. A. Kovalevskaya

S.M. Kirov Military Medical Academy

Email: vlasaluk@yandex.ru
ORCID iD: 0000-0002-3784-8473
SPIN-code: 6229-1315
Russian Federation, St. Petersburg

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Supplementary files

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2. Fig. 1. DEA/Am ratio in patients with thyrotoxicosis, hypothyroidism and euthyroidism during amiodarone therapy. Adapted from [15]

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3. Fig. 2. Pathogenesis of AIT

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4. Fig. 3. The timing of the onset of AIT types 1 and 2 from the moment of administration of amiodarone. Adapted from [28]

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5. Fig. 4. Representative images of a 99m Tc-MIBI thyroid scan

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6. Fig. 5. Representative images and assessment of TBR by thyroid scintigraphy with 99m Tc-MIBI

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7. Fig. 6. Single point areas of blood flow in the study of the thyroid gland [31]

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8. Fig. 7. Presence of blood flow in the thyroid gland with uneven vascular distribution [31]

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9. Fig. 8. Well defined perinodular blood flow [31]

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10. Fig. 9. Pronounced peri-intranodular blood flow [31]

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11. Fig. 10. Algorithm for managing patients with AIT

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