open access
Amiodarone-induced thyroid dysfunction in the developmental period: prenatally, in childhood, and adolescence — case reports and a review of the literature


- Department of Paediatric and Adolescent Endocrinology, Paediatric Institute, Medical College, Jagiellonian University in Cracow, Cracow, Poland
- Department of Paediatric Cardiology, Paediatric Institute, Medical College, Jagiellonian University in Cracow, Cracow, Poland
open access
Abstract
Introduction: Amiodarone is an important antiarrhythmic drug used in paediatric practice, mainly in children with complex congenital cardiac diseases and/or severe arrhythmias. One of the side effects of amiodarone therapy is thyroid dysfunction, which is observed in about 20% of patients. The thyroid dysfunction may present with various forms: from subclinical changes in hormone levels to amiodaroneinduced thyrotoxicosis (AIT) and amiodarone-induced hypothyroidism (AIH).
Material and methods: We reported six patients in the age range from two weeks to 14 years, with complex congenital cardiac diseases and severe arrhythmias, who developed amiodarone-induced thyroid dysfunctions: thyrotoxicosis or hypothyroidism or both together. The clinical signs and symptoms of all thyroid dysfunctions were atypical, most patients presented with an aggravation of heart insufficiency. Our patients with thyrotoxicosis were treated with combined therapy including thionamides and corticosteroids due to the presentation of mixed-identified type of AIT.
Results: Currently, five patients (one patient’s status is unknown) are in biochemical and clinical euthyreosis; however, in one of them it was impossible to discharge amiodarone treatment. Three of them are still treated with levothyroxine, and two do not need thyroid treatment.
Conclusions: Amiodarone-induced thyroid dysfunction is usually atypical; therefore, monitoring of thyroid status before, during, and after amiodarone is demanded. AIH could significantly influence the development of the child, while AIT could significantly deteriorate the clinical status of children with complex cardiac diseases. Early and proper diagnose of AIT and AIH allows the introduction of immediate and appropriate treatment considering the cardiac condition of the young patient.
Abstract
Introduction: Amiodarone is an important antiarrhythmic drug used in paediatric practice, mainly in children with complex congenital cardiac diseases and/or severe arrhythmias. One of the side effects of amiodarone therapy is thyroid dysfunction, which is observed in about 20% of patients. The thyroid dysfunction may present with various forms: from subclinical changes in hormone levels to amiodaroneinduced thyrotoxicosis (AIT) and amiodarone-induced hypothyroidism (AIH).
Material and methods: We reported six patients in the age range from two weeks to 14 years, with complex congenital cardiac diseases and severe arrhythmias, who developed amiodarone-induced thyroid dysfunctions: thyrotoxicosis or hypothyroidism or both together. The clinical signs and symptoms of all thyroid dysfunctions were atypical, most patients presented with an aggravation of heart insufficiency. Our patients with thyrotoxicosis were treated with combined therapy including thionamides and corticosteroids due to the presentation of mixed-identified type of AIT.
Results: Currently, five patients (one patient’s status is unknown) are in biochemical and clinical euthyreosis; however, in one of them it was impossible to discharge amiodarone treatment. Three of them are still treated with levothyroxine, and two do not need thyroid treatment.
Conclusions: Amiodarone-induced thyroid dysfunction is usually atypical; therefore, monitoring of thyroid status before, during, and after amiodarone is demanded. AIH could significantly influence the development of the child, while AIT could significantly deteriorate the clinical status of children with complex cardiac diseases. Early and proper diagnose of AIT and AIH allows the introduction of immediate and appropriate treatment considering the cardiac condition of the young patient.
Keywords
amiodarone; thyrotoxicosis; hypothyroidism; congenital heart disease


Title
Amiodarone-induced thyroid dysfunction in the developmental period: prenatally, in childhood, and adolescence — case reports and a review of the literature
Journal
Issue
Article type
Original paper
Pages
392-400
Published online
2019-06-12
Page views
1432
Article views/downloads
1187
DOI
10.5603/EP.a2019.0030
Pubmed
Bibliographic record
Endokrynol Pol 2019;70(5):392-400.
Keywords
amiodarone
thyrotoxicosis
hypothyroidism
congenital heart disease
Authors
Aleksandra Furtak
Anna Wędrychowicz
Anna Kalicka-Kasperczyk
Dominika Januś
Małgorzata Wójcik
Zbigniew Kordon
Andrzej Rudziński
Jerzy B. Starzyk


- Bednarek-Tupikowska G, Filus A, Kuliczkowska J, et al. [Amiodarone and the thyroid gland]. Postepy Hig Med Dosw (Online). 2004; 58: 216–225.
- Martino E, Bartalena L, Bogazzi F, et al. The effects of amiodarone on the thyroid. Endocr Rev. 2001; 22(2): 240–254.
- Bogazzi F, Bartalena L, Martino E. Approach to the patient with amiodarone-induced thyrotoxicosis. J Clin Endocrinol Metab. 2010; 95(6): 2529–2535.
- Jastrzebska H. Effects of amiodarone on the thyroid function. Postepy Nauk Medycznych. 2012; 11: 882–887.
- Mroziński B, Bobkowski W, Siwińska A. Evaluation of influence on thyroid function of long-term therapy with amiodaron for supraventricular tachycardia in population of newborns and infants — own experience. Przegl Pediatr. 2006; 36: 119–123.
- Bossowski A. Nadczynność tarczycy u dzieci. Przyczyny, diagnostyka, objawy kliniczne i leczenie. In: Bossowski A. ed. Tyreologia wieku rozwojowego. Medical Tribune Polska, Warszawa 2013: 95–117.
- Hen K, Czarnywojtek A, Stangierski A, et al. [Effect of amiodarone on the thyroid function and safety of the therapy--what's new]. Przegl Lek. 2012; 69(10): 1135–1139.
- Hacihamdioğlu B, Berberoğlu M, Siklar Z, et al. Amiodarone-induced thyrotoxicosis in children and adolescents is a possible outcome in patients with low iodine intake. J Pediatr Endocrinol Metab. 2010; 23(4): 363–368.
- Kolesińska Z, Siuda K, Bobkowski W, et al. Amiodarone-induced thyrotoxicosis with paroxysmal supraventricular (ectopic atrial) tachycardia: case report and review of the literature. Arch Med Sci. 2013; 9(2): 372–376.
- Bartalena L, Bogazzi F, Braverman LE, et al. Effects of amiodarone administration during pregnancy on neonatal thyroid function and subsequent neurodevelopment. J Endocrinol Invest. 2001; 24(2): 116–130.
- Lomenick JP, Jackson WA, Backeljauw PF. Amiodarone-induced neonatal hypothyroidism: a unique form of transient early-onset hypothyroidism. J Perinatol. 2004; 24(6): 397–399.
- Kucharska AM, Beń-Skowronek I, Walczak M, et al. Congenital hypothyroidism — Polish recommendations for therapy, treatment monitoring, and screening tests in special categories of neonates with increased risk of hypothyroidism. Endokrynol Pol. 2016; 67(5): 536–547.
- Kanike N, Davis A, Shekhawat PS. Transient hypothyroidism in the newborn: to treat or not to treat. Transl Pediatr. 2017; 6(4): 349–358.
- Bartalena L, Bogazzi F, Chiovato L, et al. 2018 European Thyroid Association (ETA) Guidelines for the Management of Amiodarone-Associated Thyroid Dysfunction. Eur Thyroid J. 2018; 7(2): 55–66.
- Cohen-Lehman J, Dahl P, Danzi S, et al. Effects of amiodarone therapy on thyroid function. Nat Rev Endocrinol. 2010; 6(1): 34–41.
- Siuda K, Kolesińska Z, Niedziela M. [Amiodarone and thyroid function]. Kardiol Pol. 2011; 69(5): 493–498.
- Ben-Skowronek I, Jaklinska T, Szewczyk L. Skuteczne leczenie nadczynności tarczycy wywołanej amiodaronem u chłopca po wieloetapowej operacji kardiochirurgicznej. Endokrynol Ped. 2003; 2(Suppl).
- Czarnywojtek A, Warmuz-Stangierska I, Woliński K, et al. Radioiodine therapy in patients with type II amiodarone-induced thyrotoxicosis. Pol Arch Med Wewn. 2014; 124(12): 695–703.
- Krysiak R, Kowalcze K, Okopień B. [Rarer causes of thyrotoxicosis]. Przegl Lek. 2016; 73(4): 250–261.
- Ursella S, Testa A, Mazzone M, et al. Amiodarone-induced thyroid dysfunction in clinical practice. Eur Rev Med Pharmacol Sci. 2006; 10(5): 269–278.
- Czarnywojtek A, Płazińska MT, Zgorzalewicz-Stachowiak M, et al. Dysfunction of the thyroid gland during amiodarone therapy: a study of 297 cases. Ther Clin Risk Manag. 2016; 12: 505–513.
- Mateo Gavira I, Vilchez López F, Larrán Escandón L, et al. [Management of severe amiodarone-induced thyrotoxicosis after failure of standard medical treatment]. Endocrinol Nutr. 2013; 60(10): e43–e45.
- Flader M, Niedziela M. Radioiodine (I131) in the Treatment of Hyperthyroidism in Children. Endokrynol Ped. 2011; 34: 61–66.