Rapid effectiveness of prednisone and thionamides combined therapy in severe amiodarone iodine-induced thyrotoxicosis. Comparison of two groups of patients with apparently normal thyroid glands.
Treatment of amiodarone iodine-induced thyrotoxicosis is often unsuccessful. Nevertheless, severe forms require a rapidly efficient therapy. Twelve patients with severe amiodarone iodine-induced thyrotoxicosis, as demonstrated on clinical and biological findings, were studied. After amiodarone withdrawal, 6 patients (group A) were treated with thionamides alone (carbimazole 60 mg daily and benzylthiouracile 1.5 g daily), and 6 patients (group B) received in addition to the same antithyroid drugs prednisone, 0.50 to 1.25 mg/kg/day for 40 days; in group A, T4 levels did not change over the study period of 40 days; T3 levels decreased only after 30 days; clinical status did not improve. In group B: T3 and T4 levels decreased dramatically at 10 days of treatment, to values significantly lower than in group A; clinical improvement occurred mainly in patients treated with high doses of prednisone; elevated thyroglobulin levels diminished rapidly. Improvement was maintained after cessation of prednisone. The rapid effect of prednisone suggests an impairement of proteolysis of thyroglobulin possibly due to a lysosomal action.
Broussolle
C
C
Service de Médecine Interne, Diabétologie et Endocrinologie, Centre Hospitalier Lyon Sud, France.
Ducottet
X
X
Martin
C
C
Barbier
Y
Y
Bornet
H
H
Noel
G
G
Orgiazzi
J
J
D000328:Adult; D000368:Aged; D000638:Amiodarone / Q000009:adverse effects*; D002231:Carbimazole / Q000008:administration & dosage* / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011241:Prednisone / Q000008:administration & dosage* / Q000627:therapeutic use; D013889:Thiouracil / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use; D013963:Thyroid Hormones / Q000097:blood; D013971:Thyrotoxicosis / Q000097:blood / Q000139:chemically induced* / Q000188:drug therapy
D013963:Thyroid Hormones; D013889:Thiouracil; D002231:Carbimazole; D000638:Amiodarone; C019269:benzylthiouracil; D011241:Prednisone