Amiodarone and Thyroid Disease

The Hypothyroidism Revolution

How To Cure Hypothyroidism Naturally

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Risk of thyroid dysfunction is lower with lower doses ✓ TSH prior to therapy, at 4-mo intervals on amio, and for 1 y after if amio d c'd

Hypothyroidism (occurs in 10%; more common in iodine-rep/ete areas)

• Pathophysiology

(1) "Wolff-Chaikoff' effect iodine load i I uptake, organification, and release of T« & Tj

(2) inhibits T« Tj conversion

(3) ? direct immune-mediated thyroid destruction

• Normal individuals: IT«; then escape Wolff-Chaikoff effect and have t T«, 1 Tj, T TSH;

then TSH normalizes (after 1-3 mos) ■ Susceptible individuals (eg. subclinical Hashimoto's. . . / anti-TPO) do not escape effects

• Treatment thyroxine to normalize TSH; may need larger than usual dose

Hyperthyroidism (3% of Pts on amio; 10-20% of Pts in iodine-def?dent areas)

• Type 1 underlying multinodular goiter or autonomous thyroid tissue pathophysiology: Jodbasedow effect (iodine load t synthesis of T« and Tj in autonomous tissue)

diagnostic studies: T thyroid blood flow on Doppler U S; treatment: methimazole

• Type 2 destructive thyroiditis pathophysiology, t release of preformed T4 & T3 — hyperthyroidism hypothyroidism » recovery diagnostic studies: * ESR, I flow on Doppler U S; treatment: steroids

• Type 1 vs. 2 often difficult to distinguish and Rx for both initiated (jcem 2001:86:3)

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