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Health Sci Rep. 2018 Apr 16;1(5):e36. doi: 10.1002/hsr2.36. eCollection 2018 May.

Amiodarone-induced thyrotoxicosis in heart failure with a reduced ejection fraction: A retrospective cohort study.

Author information

1
Department of Medicine University of Calgary Calgary Alberta Canada.
2
Department of Internal Medicine, Rady Faculty of Health Science, Max Rady College of Medicine University of Manitoba Winnipeg Manitoba Canada.
3
Section of Endocrinology, Rady Faculty of Health Sciences, Max Rady College of Medicine University of Manitoba Winnipeg Manitoba Canada.
4
Department of Community Health Sciences University of Calgary Calgary Alberta Canada.
5
Section of Cardiology, Rady Faculty of Health Sciences, Max Rady College of Medicine University of Manitoba Winnipeg Manitoba Canada.

Abstract

Background:

Amiodarone-induced thyrotoxicosis (AIT) is associated with significant morbidity and mortality. We aimed to describe AIT and its clinical outcomes in patients with heart failure with reduced ejection fraction (HFrEF).

Methods:

We performed a retrospective chart review at a heart failure center in Winnipeg, Canada. We screened 1059 consecutive patients seen over a 12-month period (August 2011 to July 2012) for AIT in patients with HFrEF. Using descriptive and Cox proportional hazard analyses, we explored the association between AIT and mortality.

Results:

A total of 110 patients with HFrEF who were exposed to amiodarone were included in the analysis. Of these, 13 (11.8%) were diagnosed with AIT. All AIT patients in our cohort were male. Amiodarone was discontinued in nearly half (46.2%) of patients with AIT. All patients were treated with antithyroid medications, and 5 patients (38.5%) also received prednisone. Euthyroidism was achieved in 2 patients (15.4%), hypothyroidism occurred in 6 patients (46.2%), and 5 patients remained thyrotoxic until death or time of chart review (38.5%).

Conclusion:

Thyrotoxicosis is common in patients with HFrEF on amiodarone and is challenging to treat. Due to the sample size, while no association was found in mortality for patients with HFrEF with AIT, a real association could have been missed.

KEYWORDS:

amiodarone side effects; amiodarone‐induced thyrotoxicosis; heart failure; heart failure‐reduced ejection fraction; systolic heart failure; thyroid; thyrotoxicosis

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