Author + information
- Received August 23, 2006
- Revision received February 8, 2007
- Accepted February 12, 2007
- Published online June 19, 2007.
- David Conen, MD⁎,
- Ludovic Melly⁎,
- Christoph Kaufmann, MD⁎,
- Stefan Bilz, MD†,
- Peter Ammann, MD⁎,
- Beat Schaer, MD⁎,
- Christian Sticherling, MD⁎,
- Beat Muller, MD† and
- Stefan Osswald, MD, FACC, FESC⁎,⁎ ()
- ↵⁎Reprint requests and correspondence:
Dr. Stefan Osswald, Cardiology, University Hospital, Petersgraben 4, 4031 Basel, Switzerland.
Objectives This study sought to determine the clinical course and predictors of long-term outcome in patients with documented amiodarone-induced thyrotoxicosis (AIT).
Background Amiodarone-induced thyrotoxicosis is a condition that is difficult to manage, in particular because of the long half-life of amiodarone. Data on optimal treatment for AIT are scarce.
Methods We performed a retrospective review among patients with documented AIT at a tertiary care center. Baseline characteristics, treatment received, laboratory parameters, and events during follow-up were evaluated. The predefined composite end point consisted of the following AIT-associated complications: death, heart transplantation, hospitalization for heart failure, myocardial infarction, stroke, hospitalization for arrhythmia management, or hospitalization for treatment complications.
Results Eighty-four patients were included in the present analysis; 27 patients received prednisone for AIT. There was no difference in time to normalization of free thyroxine between those receiving and those not receiving prednisone. Long-term follow-up showed high morbidity and mortality; 47 patients (56%) reached the primary end point. Patients receiving prednisone had a worse outcome than those not receiving prednisone (p = 0.003). Although patients received prednisone for 84 ± 65 days, curves started to separate only 12 months after the initial diagnosis.
Conclusions Patients with AIT have a high event rate during follow-up. Prednisone had no effect on time to normalization of thyroxine levels and was associated with an increased event rate. Importantly, AIT-related problems must be expected late, at a time when thyroid function is under control.
The first two authors contributed equally to this work.
- Received August 23, 2006.
- Revision received February 8, 2007.
- Accepted February 12, 2007.
- American College of Cardiology Foundation