[en] Amiodarone-associated thyrotoxicosis, often clinically mild and resolutive after amiodarone discontinuation or under medical therapy, is sometimes drug unresponsive and not uncommonly follows a dramatic, even fatal course. Therefore, we considered a surgical solution in 15 severely amiodarone-associated thyrotoxic patients. Twelve men and three women (mean age 68 years, range 50-84 years) underwent radical thyroidectomy for clinical and biologically proved amiodarone-associated thyrotoxicosis. In six surgery was the first-line therapeutic option. In the other nine thyroidectomy seemed unavoidable considering the unresponsiveness to medical therapy and rapid deterioration of the patients' clinical condition, with life-threatening cardiac failure in three. In every patient surgery was conducted without immediate or delayed complications. Total thyroidectomy proved uniformly, definitively, and rapidly effective in controlling thyrotoxicosis in all patients, with a spectacular reversal of cardiac failure in the three most critical cases. Surgery was beneficial to our 15 patients and undoubtedly life-saving in the three most worrying cases. These results suggest that thyroidectomy should be more liberally regarded as an interesting alternative to conventional, but unpredictably effective, medical therapies.
Disciplines :
Anesthesia & intensive care Surgery
Author, co-author :
Hamoir, Etienne ; Centre Hospitalier Universitaire de Liège - CHU > Chirurgie abdominale- endocrinienne et de transplantation
Meurisse, Michel ; Centre Hospitalier Universitaire de Liège - CHU > Chirurgie abdominale- endocrinienne et de transplantation
Defechereux, Thierry ; Centre Hospitalier Universitaire de Liège - CHU > Chirurgie abdominale- endocrinienne et de transplantation
Joris, Jean ; Centre Hospitalier Universitaire de Liège - CHU > Anesthésie et réanimation
Vivario, Janine ; Centre Hospitalier Universitaire de Liège - CHU > Anatomie pathologique
Hennen, Georges ; Centre Hospitalier Universitaire de Liège - CHU > Endocrinologie clinique
Language :
English
Title :
Surgical management of amiodarone-associated thyrotoxicosis: too risky or too effective?
Publication date :
1998
Journal title :
World Journal of Surgery
ISSN :
0364-2313
eISSN :
1432-2323
Publisher :
Springer Verlag, New York, United States - New York
Harjai, K.J., Licata, A.A., Effects of amiodarone on thyroid function (1997) Ann. Intern. Med., 126, p. 63
Reiffel, J.A., Estes, N.A., Waldo, A.L., Prystowsky, E.N., DiBianco, R., A consensus report on antiarrhythmic drug use (1994) Clin. Cardiol., 17, p. 103
Ceremuzynski, L., Kleczar, E., Krzeminska-Pakula, M., Kuch, J., Nartowicz, E., Smielak-Korombel, J., Dyduszynski, A., Yusuf, S., Effects of amiodarone on mortality after myocardial infarction: A double-blind, placebo-controlled, pilot study (1992) J. Am. Coll. Cardiol., 20, p. 1056
Chatterjee, K., Amiodarone in chronic heart failure (1989) J. Am. Coll. Cardiol., 14, p. 1775
Nademanee, K., Piwonka, R.W., Singh, B.N., Hershman, J.M., Amiodarone and thyroid function (1989) Prog. Cardiovasc. Dis., 37, p. 427
Rao, R.H., McCready, V.R., Spathis, G.S., Iodine kinetic studies during amiodarone treatment (1986) J. Clin. Endocrinol. Metab., 62, p. 563
Lombardi, A., Martino, E., Braverman, L.E., Amiodarone and the thyroid (1990) Thyroid Today, 13, p. 1
Mehra, A., Widerhorn, J., Lopresti, J., Rahimtoola, S.H., Amiodarone-induced hyperthyroidism: Thyroidectomy under local anesthesia (1991) Am. Heart J., 122, p. 1160
Meurisse, M., Hamoir, E., D'Silva, M., Joris, J., Hennen, G., Amiodarone-induced thyrotoxicosis: Is there a place for surgery? (1993) World J. Surg., 17, p. 622
Broussolle, C., Ducottet, X., Martin, C., Barbier, Y., Bornet, H., Noel, G., Orgiazzi, J., Rapid effectiveness of prednisone and thionamides combined therapy in severe amiodarone iodine-induced thyrotoxicosis: Comparison of two groups of patients with apparently normal glands (1989) J. Endocrinol. Invest., 12, p. 37
Martino, E., Safran, M., Aghini-Lombardi, F., Rajatanavin, R., Lenziardi, M., Fay, M., Pacchiarotti, A., Haffajee, C., Environmental iodine intake and thyroid dysfunction during chronic amiodarone therapy (1984) Ann. Intern. Med., 101, p. 28
Meurisse, M., Hamoir, E., Joris, J., Beckers, A., Hennen, G., L'Hyperthyroïdie sévère associée à la prise d'amiodarone: Une urgence chirurgicale (1995) Lyon Chir., 91, p. 480
Brennan, M.D., Van Heerden, J.A., Carney, J.A., Amiodarone-associated thyrotoxicosis (AAT): Experience with surgical management (1987) Surgery, 102, p. 1062
Harjai, K.J., Licata, A.A., Amiodarone induced hyperthyroidism: A case series and brief review of literature (1996) Pacing Clin. Electrophysiol., 19, p. 1548
Martino, E., Aghini-Lombardi, F., Mariotti, S., Bartalena, L., Braverman, L., Pinchera, A., Amiodarone: A common source of iodine-induced thyrotoxicosis (1987) Horm. Res., 26, p. 158
Bartalena, L., Grasso, L., Brogioni, S., Aghini-Lombardi, F., Braverman, L., Martino, E., Serum interleukin-6 in amiodarone-induced thyrotoxicosis (1994) J. Clin. Endocrinol. Metab., 78, p. 423
Peche, R., Abramowicz, M., Unger, J., Failure to respond to dexamethasone with fatal consequences, after initial response to multidrug treatment in a case of amiodarone-associated thyrotoxicosis (1992) Am. J. Med., 93, p. 702
Bronstein, V., Coignard, A., Gauthier, D., Duret, J.C., Droniou, J., Thyrotoxicose sévère et surcharge iodée: A propos d'un cas d'évolution mortelle (1982) Presse Med., 11, p. 2226
Hauptman, P.J., Fyfe, B., Mechanick, J., Lansman, S., Gass, A., Fatal hyperthyroidism after amiodarone treatment and total lymphoid irradiation in a heart transplant recipient (1993) J. Heart Lung Transplant., 12, p. 513
Leger, A.F., Massin, J.P., Laurent, M.F., Vincens, M., Auriol, M., Helal, O.B., Chomette, G., Savoie, J.C., Iodine-induced thyrotoxicosis: Analysis of eighty-five consecutive cases (1984) Eur. J. Clin. Invest., 14, p. 449
Rosenbaum, M.B., Chiale, P.A., Haedo, A., Lazzari, J.O., Elizari, M.V., Ten years of experience with amiodarone (1983) Am. Heart J., 106, p. 957
Farwell, A.P., Abend, S.L., Huang, S.K., Patwardhan, N.A., Braverman, L.E., Thyroidectomy for amiodarone-induced thyrotoxicosis (1990) J.A.M.A., 263, p. 1526
Newnham, H.H., Chosich, N., Topliss, D.J., Le Grand, B.A., Harper, R.W., Stockigt, J.R., Amiodarone-induced hyperthyroidism: Assessment of the predictive value of biochemical testing and response to combined therapy using propylthiouracil and potassium perchlorate (1988) Aust. N.Z. J. Med., 18, p. 31
Johnson, R.S., Moore, W.G., Fatal aplastic anemia after treatment of thyrotoxicosis with potassium perchlorate (1961) B.M.J., 1, p. 1369
Uzzan, B., Pussard, E., Leon, A., Bekhechi, D., Krivitzky, A., Modigliani, E., Perret, G., Guidicelli, J.F., The effects of plasmapheresis on thyroid hormone and plasma drug concentralions in amiodarone-induced thyrotoxicosis (1991) Br. J. Clin. Pharmacol., 31, p. 371
Mulligan, D.C., McHenry, C.R., Kinney, W., Esselstyn, C.B., Amiodarone-induced thyrotoxicosis: Clinical presentation and expanded indications for thyroidectomy (1993) Surgery, 114, p. 1114
Koblin, D.D., Romanoff, M.E., Martin, D.E., Hensley, F.A., Larach, D.R., Stauffer, R.A., Luck, J., Anesthetic management of the parturient receiving amiodarone (1987) Anesthesiology, 66, p. 551
Leger, A.F., Fragu, P., Rougier, P., Laurent, M.F., Tubiana, M., Savoie, J.C., Thyroid iodine content measured by x-ray fluorescence in amiodarone-induced thyrotoxicosis: Concise communication (1983) J. Nucl. Med., 24, p. 582
Reichert, L.J., De Rooy, H.A., Treatment of amiodarone induced hyperthyroidism with potassium perchlorate and methimazole during amiodarone treatment (1989) B.M.J., 298, p. 1547
Lambert, M., Unger, J., De Nayer, P., Brohet, C., Gangji, D., Amiodarone-induced thyrotoxicosis suggestive of thyroid damage (1990) J. Endocrinol. Invest., 13, p. 527