LETTER
Amiodarone and Thyroid Function
James R. Biddle, MD
15 October 1997 | Volume 127 Issue 5 Part 1 | Page 653
TO THE EDITOR:
In reviewing the effects of amiodarone on thyroid physiology, Harjai and Licata [1] state that amiodarone "decreases the peripheral deiodination of thyroxine to triiodothyronine ... resulting in an increase of serum levels of thyroxine and reverse triiodothyronine and a decrease of serum levels of triiodothyronine (by 20% to 25%), as seen in the euthyroid sick syndrome." However, in discussing treatment options for amiodarone-induced hypothyroidism, they recommend replacement therapy with levothyroxine. Perhaps we have blinders on about the potential advantages of replacement therapy using triiodothyronine or a combination of triiodothyronine and thyroxine.
In clinical practice, I have seen good results with triiodothyronine or triiodothyronine and thyroxine in patients with generalized illness, clinical hypothyroidism, elevated thyroid-stimulating hormone levels, normal free thyroxine levels, and low free triiodothyronine levels, consistent with defective peripheral deiodination. Of note, many of these patients did not tolerate replacement therapy with levothyroxine alone, often because of palpitations, anxiety, or other side effects consistent with overreplacement, despite persistent elevations of thyroid-stimulating hormone levels.
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Author and Article Information
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Carolina Center for Metabolic Medicine; Asheville, NC 28801
1. Harjai KJ, Licata AA. Effects of amiodarone on thyroid function. Ann Intern Med. 1997; 126:63-73.
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