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  • Title: The Effects of Amiodarone on Thyroid Function in Pediatric and Young Adult Patients.
    Author: Barrett B, Hawkes CP, Isaza A, Bauer AJ.
    Journal: J Clin Endocrinol Metab; 2019 Nov 01; 104(11):5540-5546. PubMed ID: 31361319.
    Abstract:
    CONTEXT: Amiodarone is used in patients with arrhythmias, but thyroid dysfunction [amiodarone-induced thyrotoxicosis (AIT) or amiodarone-induced hypothyroidism (AIH)] is a common adverse effect. As the onset of AIT and AIH has not been studied in children, the timing of dysfunction and long-term monitoring are not known in this population. OBJECTIVE: To describe the incidence and timing of amiodarone-induced thyroid dysfunction in children and adolescents, with a secondary aim to identify risk factors for amiodarone-induced thyroid dysfunction, and to identify variance in thyroid hormone surveillance and treatment. DESIGN: Retrospective review of thyroid dysfunction in children and young adults treated with amiodarone between 2007 and 2018. SETTING: Children's Hospital of Philadelphia. PATIENTS: Children and young adults treated with amiodarone. MAIN OUTCOME MEASURES: Prevalence of amiodarone-induced thyroid dysfunction. RESULTS: Of 484 patients, 190 had thyroid-function testing; 17.3% were found to have subclinical hypothyroidism, and 13.7% testing developed hypothyroidism. Hyperthyroidism occurred in 2.1%. In patients with subclinical hypothyroidism, 63% returned to normal thyroid function without thyroid hormone replacement. Only 26% of patients with hypothyroidism had spontaneous normalization of thyroid function. Twenty-five percent of AIT patients had spontaneous normalization of thyroid function. CONCLUSIONS: This study looks at a pediatric and young-adult population in an effort to describe the natural history of amiodarone-induced thyroid dysfunction. Based on our data, we recommend that a complete thyroid-function panel be obtained within the first week and then at weekly intervals for the first 5 weeks after initiation. The majority of thyroid dysfunction was noted within the first 35 days of treatment.
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