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Use of Oral Cholecystographic Agents in the Treatment of Amiodarone-Induced Hyperthyroidism

Division of Endocrinology, Diabetes, and Hypertension, Department of Medicine, University of California Center for Health Sciences, Los Angeles, California 90024

Address all correspondence and requests for reprints to: Inder J. Chopra, M.D., Division of Endocrinology, Metabolism, Diabetes, and Metabolism, 900 Veteran Avenue, Suite 24-130, Warren Hall, Los Angeles, California 90095-7073. E-mail: ichopra{at}mednet.ucla.edu

Abstract

We describe here five cardiac patients with type II amiodarone-induced hyperthyroidism who were treated prospectively with a combination of an oral cholecystographic agent (sodium ipodate, Oragrafin, or sodium iopanoate, Telepaque) and a thionamide (propylthiouracil or methimazole); amiodarone was discontinued in all patients. All patients improved substantially clinically within a few days of treatment and became euthyroid or hypothyroid in 15–31 wk when treatment was discontinued. Four of the five became hypothyroid and required long-term treatment with L-T₄; the remaining patient was euthyroid, but died from cardiomyopathy and congestive heart failure at 29 wk, when he had been off oral cholecystographic agent and thionamide for 6 wk. We did not find any clinical or biochemical adverse effects of the treatment. Our study suggests that a combination of oral cholecystographic agent and thionamide is a safe and effective treatment of type II amiodarone-induced hyperthyroidism. Data also suggest that hypothyroidism is a common end result of type II amiodarone-induced hyperthyroidism.

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