What is the role of surgery in the treatment of amiodarone-induced thyrotoxicosis (AIT)?

Updated: Aug 28, 2020
  • Author: Mini Gopalan, MD; Chief Editor: Romesh Khardori, MD, PhD, FACP  more...
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Answer

Total or near-total thyroidectomy is performed in cases of AIT that fail to respond to combination therapy with thionamides, perchlorate, and corticosteroids. Thyroidectomy is also performed in patients who need amiodarone therapy but whose resulting hyperthyroidism does not respond to medical treatment. In addition, it is carried out for immediate control of a thyrotoxic state (eg, during thyroid storm), as well as in patients with intractable arrhythmias. Treat the resulting hypothyroidism with thyroid hormone replacement. Despite the minimally elevated risk due to underlying heart disease, surgery is reasonably safe in these patients and can even be performed with local anesthesia.

A retrospective cohort study by Cappellani et al indicated that in patients with AIT and a left ventricular ejection fraction (LVEF) of less than 40%, those who undergo total thyroidectomy after euthyroidism has been restored, and thus have longer exposure to thyrotoxicosis, have a higher mortality rate (peritreatment mortality rate: 40%; 5-year cardiovascular mortality rate: 53.3%) than do those who undergo the surgery while still thyrotoxic (0% and 12.3% mortality rates, respectively). In contrast, survival rates in study patients with an LVEF of 40% or above did not significantly differ with regard to whether or not they were euthyroid when total thyroidectomy was performed. [14]


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