[Treatment of amiodarone-induced hyperthyroidism: corticosteroids or potassium perchlorate? What value do interleukin-6 levels have?].
We report 11 cases of amiodarone-induced hyperthyroidism. We tried to classify them into 2 groups, according to Bartelena et al. (JCEM 81: 2930, 1996). The serum level of interleukin-6 (IL-6) was measured in 7 patients by an immunoenzymometric assay. In type I (cases 1-3) the thyroid was abnormal (goiter, Graves' disease) but IL-6 levels were normal. These cases were successfully managed by the combined use of thionamide drugs (carbimazol or propylthioruacil = PTU) and potassium perchlorate. In type II (case 4), the thyroid seemed to be normal but the serum level of IL-6 was increased, possibly due to a destructive thyroiditis. Treatment with prednisone (40 mg/day) and PTU resulted in a prompt normalization of T3. Contrary to Bartalena et al., we observed cases with normal thyroid and normal levels of IL-6 (cases 5-8) (type III). In these cases prednisone (40 mg/day for 2 weeks) was ineffective but the combined use of thionamide drugs and perchlorate was associated with a normalization of thyroid hormones. This combined treatment seems to be effective in most patients (type I, III). In case of failure of this treatment, a high dose of prednisone (1 mg/kg) could be tried or a lower dosage (40 mg/day) could be used in cases with high IL-6 levels (type II).
Martin-Du Pan
R
R
Konfino
O
O
Zimmermann
M
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000638:Amiodarone / Q000009:adverse effects*; D000889:Anti-Arrhythmia Agents / Q000009:adverse effects*; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D013956:Antithyroid Agents / Q000627:therapeutic use*; D002648:Child; D016903:Drug Monitoring; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D006980:Hyperthyroidism / Q000097:blood / Q000139:chemically induced* / Q000188:drug therapy* / Q000276:immunology; D015850:Interleukin-6 / Q000097:blood*; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D010472:Perchlorates / Q000627:therapeutic use*; D017680:Potassium Compounds / Q000627:therapeutic use*; D011241:Prednisone / Q000627:therapeutic use*
D000889:Anti-Arrhythmia Agents; D000893:Anti-Inflammatory Agents; D013956:Antithyroid Agents; D015850:Interleukin-6; D010472:Perchlorates; D017680:Potassium Compounds; C009006:potassium perchlorate; D000638:Amiodarone; D011241:Prednisone