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Published online: 2019-06-12
Submitted: 2019-02-05
Accepted: 2019-06-02
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Amiodarone – induced thyroid dysfunction in the developmental period: prenatally, in childhood, and adolescence

Anna Wędrychowicz, Aleksandra Furtak, Anna Kalicka-Kasperczyk, Dominika Januś, Małgorzata Wójcik, Zbigniew Kordon, Andrzej Rudziński, Jerzy B Starzyk
DOI: 10.5603/EP.a2019.0030
·
Pubmed: 31274186

open access

Ahead of print
Original papers
Published online: 2019-06-12
Submitted: 2019-02-05
Accepted: 2019-06-02

Abstract

Introduction Amiodarone is an important antiarrhythmic drug, in pediatric practice used mainly in children with complex congenital cardiac diseases and/or severe arrhythmias. The side effects of amiodarone therapy include thyroid dysfunction with the incidence ranges about 20%. The thyroid dysfunction may have various forms: from subclinical changes in hormone concentrations to amiodarone – induced thyrotoxicosis (AIT) and amiodarone – induced hypothyroidism (AIH). Material and methods We reported six patients at the age 2 weeks - 14 years, with complex congenital cardiac diseases and severe arrhythmias, who developed amiodarone – induced thyroid dysfunctions as thyrotoxicosis, or hypothyroidism, or both together. The clinical signs and symptoms of all thyroid dysfunctions were atypical, most patients presented with aggravation of the heart insufficiency. Our patients with thyrotoxicosis were treated with combined therapy including as well thionamides as corticosteroids due to the presentation of mixed–identified type of AIT. Results Currently all five patients (current status of one is unknown) are in biochemical and clinical euthyreosis, however in one of them it was impossible to discharge amiodarone treatment. Four of them is still treated with L-thyroxine, one 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 to introduce the immediate and appropriate treatment considering the cardiac condition of the young patient.

Abstract

Introduction Amiodarone is an important antiarrhythmic drug, in pediatric practice used mainly in children with complex congenital cardiac diseases and/or severe arrhythmias. The side effects of amiodarone therapy include thyroid dysfunction with the incidence ranges about 20%. The thyroid dysfunction may have various forms: from subclinical changes in hormone concentrations to amiodarone – induced thyrotoxicosis (AIT) and amiodarone – induced hypothyroidism (AIH). Material and methods We reported six patients at the age 2 weeks - 14 years, with complex congenital cardiac diseases and severe arrhythmias, who developed amiodarone – induced thyroid dysfunctions as thyrotoxicosis, or hypothyroidism, or both together. The clinical signs and symptoms of all thyroid dysfunctions were atypical, most patients presented with aggravation of the heart insufficiency. Our patients with thyrotoxicosis were treated with combined therapy including as well thionamides as corticosteroids due to the presentation of mixed–identified type of AIT. Results Currently all five patients (current status of one is unknown) are in biochemical and clinical euthyreosis, however in one of them it was impossible to discharge amiodarone treatment. Four of them is still treated with L-thyroxine, one 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 to introduce the immediate and appropriate treatment considering the cardiac condition of the young patient.

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Keywords

amiodarone, thyrotoxicosis, hypothyroidism, congenital heart disease

About this article
Title

Amiodarone – induced thyroid dysfunction in the developmental period: prenatally, in childhood, and adolescence

Journal

Endokrynologia Polska

Issue

Ahead of print

Published online

2019-06-12

DOI

10.5603/EP.a2019.0030

Pubmed

31274186

Keywords

amiodarone
thyrotoxicosis
hypothyroidism
congenital heart disease

Authors

Anna Wędrychowicz
Aleksandra Furtak
Anna Kalicka-Kasperczyk
Dominika Januś
Małgorzata Wójcik
Zbigniew Kordon
Andrzej Rudziński
Jerzy B Starzyk

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