ECE2023 Poster Presentations Thyroid (163 abstracts)
Severe post-amiodarone thyrotoxicosis: personalized approach for radical treatment in a life-threatening condition
Marta Opalinska 1 , Jacek Pantoflinski 2 , Grzegorz Sokołowski 1 , Dorota Pach 1 , Marta Kostecka-Matyja 1 , Katarzyna Żabicka 2 , Bartosz Partyński 1 , Małgorzata Kieć-Klimczak 2 , Anna Sowa-Staszczak 1 , Monika Buziak-Bereza 1 , Aleksandra Gilis-Januszewska 1 & Alicja Hubalewska-Dydejczyk 1
1Jagiellonian University Medical College, Chair and Department of Endocrinology, Kraków, Poland; 2University Hospital in Krakow, Endocrinology, Oncological Endocrinology and Nuclear Medicine Department, Krakow, Poland
Background: Despite increased awareness among cardiologists about the risk of amiodarone’s significant side effects, it is still a commonly used antiarrhythmic drug. Amiodarone may induced easy for management hypothyroidism which affect even 25% of patients or less frequent thyrotoxicosis (AIT) which causes a challenge for clinicians. Type 1 of AIT occurs on the basis of pre-existing thyroid diseases such as nodular goiter or latent Graves’ disease, type 2 results from destructive thyroiditis, and mixed/indefinite forms combine both pathomechanisms. Initial treatment of AIT includes the use of thioamides accompanied by glucocorticoids and/or perchlorate. Unfortunately, some patients refractory to this treatment may develop life-threatening symptoms. In such cases, an urgent decision must be made on salvage radical treatment. AIT induced exacerbation of cardiac insufficiency and life-threatening arrhythmias causes anaesthesia for thyroidectomy and 131-I (low 131-I uptake) therapy challenging. We aimed to assess the clinical course and results of salvage thyroidectomy or 131-I therapy in patients with life-threatening AIT refractory to medical treatment.
Materials and Methods: 75 patients, hospitalized due to severe cardiac insufficiency or arrhythmias associated with AIT between 2014-2022 at a single tertiary center.
Results: In 73 of 75 patients amiodaron was withdrawn at admission. All patients received thiamazole as the best conservative treatment. Glucocorticosteroids were applied in 60, sodium perchlorate in 38, lithium carbonicum in 10 and albumins in 16 patients. The sequence of medications used depended on the individual course of the disease. In the whole group, 20 patients required salvage radical therapy due to the worsening of clinical symptoms. Six patients died during hospitalization before any radical treatment was applied. Further, 6 patients underwent total thyroidectomy. 131-I treatment was carried out in 8 cases (6 patients after rhTSH stimulation). In 4 patients a single dose of 131-I was sufficient. Four patients required repeated 131-I therapy due to thyrotoxicosis recurrence, but the partial response to first 131-I therapy enabled its repetition at the time of cardiac improvement.
Conclusion: AIT may be associated with life-threatening symptoms resulting from the exacerbation of cardiac failure and arrhythmias. The decision on the optimal time for radical AIT treatment is critical and cannot be taken too late. In selected group of patients at high risk of anaesthesia, an 131-I treatment can be considered as an effective therapeutic option. In some patients, the administration of rhTSH may be useful to improve 131-I uptake.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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