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ARTICLE |

Treatment Guidelines for Hyperthyroidism and Hypothyroidism FREE

Saeed Ahmad, MD
[+] Author Affiliations

Edited by Margaret A. Winker, MD, Senior Editor, and Phil B. Fontanarosa, MD, Senior Editor.


JAMA. 1995;274(13):1011-1011. doi:10.1001/jama.1995.03530130017007
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Published online

To the Editor.  —The excellent Special Communication by Dr Singer and colleagues1 gives guidelines for use by physicians in the care of patients with thyroid disorders. However, I was surprised that Singer et al did not mention the role of amiodarone in causing thyroid disorder.2,3 Amiodarone is an iodinated molecule containing 37.2% of its molecular weight as iodine; therefore, it may cause thyroid dysfunction. Amiodarone has been reported to cause both thyrotoxicosis and hypothyroidism.2,3 Middlekauf et al4 published an excellent review of amiodarone therapy in patients with atrial fibrillation. Amiodarone therapy is being used widely for treatment of atrial fibrillation and congestive heart failure.5Amiodarone therapy should have been added to the guidelines so that physicians may be made aware of this iatrogenic thyroid disorder.

REFERENCES

Singer PA, Cooper DS, Levy EG, et al.  Treatment guidelines for patients with hyperthyroidism and hypothyroidism. JAMA . 1995;;273:808-812.
Trip MD, Wiersinga W, Pomp TA.  Incidence, predictability and pathogenesis of amiodarone-induced thyrotoxicosis and hypothyroidism. Am J Med . 1991;;91:502-522.
Chiovato L, Martino E, Tonacchera M, et al.  Studies on the in vitro cytotoxic effect of amiodarone. Endocrinology . 1994;;134:2277-2282.
Middlekauf HR, Weiner I, Saxon LA, Stevenson WG.  Low-dose amiodarone for atrial fibrillation: time for a prospective study? Ann Intern Med . 1992;; 116:1017-1020.
Dovel HC, Nul DR, Grancilli HO, et al.  Randomised trial of low-dose amiodarone in severe congestive heart failure. Lancet . 1994;;344:493-498.

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Singer PA, Cooper DS, Levy EG, et al.  Treatment guidelines for patients with hyperthyroidism and hypothyroidism. JAMA . 1995;;273:808-812.
Trip MD, Wiersinga W, Pomp TA.  Incidence, predictability and pathogenesis of amiodarone-induced thyrotoxicosis and hypothyroidism. Am J Med . 1991;;91:502-522.
Chiovato L, Martino E, Tonacchera M, et al.  Studies on the in vitro cytotoxic effect of amiodarone. Endocrinology . 1994;;134:2277-2282.
Middlekauf HR, Weiner I, Saxon LA, Stevenson WG.  Low-dose amiodarone for atrial fibrillation: time for a prospective study? Ann Intern Med . 1992;; 116:1017-1020.
Dovel HC, Nul DR, Grancilli HO, et al.  Randomised trial of low-dose amiodarone in severe congestive heart failure. Lancet . 1994;;344:493-498.
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To understand the clinical management of acute heart failure syndromes.
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