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Glucocorticoids Are Preferable to Thionamides as First-Line Treatment for Amiodarone-Induced Thyrotoxicosis due to Destructive Thyroiditis: A Matched Retrospective Cohort Study

Department of Endocrinology and Metabolism (F.B., L.T., E.D., E.M.), University of Pisa, 56124 Pisa, Italy; Department of Clinical Medicine, University of Insubria (L.B.), 21100 Varese, Italy; and Unit of Epidemiology and Biostatistics, Institute of Clinical Physiology, National Research Council and G. Monasterio Foundation (G.R., P.P.), 56124 Pisa, Italy

Address all correspondence and requests for reprints to: Fausto Bogazzi, M.D., Department of Endocrinology and Metabolism, University of Pisa, Ospedale Cisanello, Via Paradisa, 2, 56124 Pisa, Italy. E-mail: f.bogazzi{at}endoc.med.unipi.it; or fbogazzi{at}hotmail.com.

Context: Type 2 amiodarone-induced thyrotoxicosis (AIT) is a destructive thyroiditis usually responsive to glucocorticoids; however, recent surveys showed that many expert thyroidologists worldwide use thionamides for type 2 AIT patients.

Objective: The objective of the study was to compare the effectiveness of methimazole (MMI) or prednisone (GLU) in type 2 AIT patients who had a short cure time according to a published predictive model.

Design: This was a matched retrospective cohort study.

Setting: The study was conducted at a university center.

Patients: Forty-two untreated type 2 AIT patients with a predicted cure time 40 d were divided into two groups (MMI and GLU groups). After matching for the predicted cure time, patients in the GLU group were selected in a 1:1 ratio to patients in the MMI group.

Intervention: Patients were treated with GLU or MMI for 40 d. Patients still thyrotoxic after 40 d continued glucocorticoids if in the GLU group or were switched to prednisone (MMI-GLU group) if in the MMI group.

Main Outcome Measure: Time and rate of cure (healing) at 40 d were measured.

Results: Patients still thyrotoxic after 40 d were 23.8 ± 9.3% in the GLU group and 85.7 ± 7.6% in the MMI group (P = 0.000). The GLU and MMI-GLU groups did not significantly differ in the nonhealing rate at 40 d (P = 0.730). When patients in the MMI group were treated with glucocorticoids, 94.1% patients achieved euthyroidism within 40 d. However, the global median cure time (MMI period + prednisone period) was longer (60 d, 95% confidence interval 53.5–66.5 d) in the MMI-GLU group than the GLU group (21 d, 95% confidence interval 15.1–26.9 d).

Conclusions: Glucocorticoids are the first-line treatment in type 2 AIT, whereas thionamides play no role in this destructive thyroiditis.