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Environmental Iodine Intake and Thyroid Dysfunction During Chronic Amiodarone Therapy

ENIO MARTINO, M.D.; MARJORIE SAFRAN, M.D.; FABRIZIO AGHINI-LOMBARDI, M.D.; RAJATA RAJATANAVIN, M.D.; MASSIMO LENZIARDI, M.D.; MADELEINE FAY, M.D.; ALESSANDRO PACCHIAROTTI, M.D.; NEIL ARONIN, M.D.; ENRICO MACCHIA, M.D.; CHARLES HAFFAJEE, M.D.; LEONARDO ODOGUARDI, M.D.; JOHN LOVE, M.D.; ALDO BIGALLI, M.D.; LIDIO BASCHIERI, M.D.; ALDO PINCHERA, M.D.; and LEWIS BRAVERMAN, M.D.
[+] Article and Author Information

Presented in part at the Annual Meeting of the American Thyroid Association, New Orleans, Louisiana, 5-8 October 1983.

▸Requests for reprints should be addressed to Lewis Braverman, M.D.; Division of Endocrinology and Metabolism, Department of Medicine, University of Massachusetts Medical Center, 55 Lake Avenue North; Worcester, MA 01605.


Pisa and Lucca, Italy; and Worcester, Massachusetts


© 1984 American College of PhysiciansAmerican College of Physicians


Ann Intern Med. 1984;101(1):28-34. doi:10.7326/0003-4819-101-1-28
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Amiodarone, an iodine-containing drug used frequently in the treatment of cardiac arrhythmias and angina pectoris, has many effects on thyroid hormone metabolism, including decreasing the production of triiodothyronine (T3) and decreasing the clearance of thyroxine and reverse T3. These effects result in elevated serum thyroxine and reverse T3 concentrations and decreased serum T3 concentrations. In addition, iodine-induced hyperthyroidism or hypothyroidism may occur in patients chronically treated with amiodarone. This study is a retrospective analysis of the incidence of thyroid dysfunction in Lucca and Pisa, West Tuscany, Italy, and in Worcester, Massachusetts. Hyperthyroidism was a more frequent (9.6%) complication of amiodarone therapy in West Tuscany, where iodine intake is moderately low; hypothyroidism was more frequent (22%) in Worcester, where iodine intake is sufficient. In patients receiving chronic amiodarone therapy, clinically suspected hyperthyroidism is best confirmed by showing elevations in serum T3 or free T3 concentrations; hypothyroidism is best diagnosed by showing an elevated serum thyrotrophin concentration. Thyroid function should be carefully monitored in patients receiving amiodarone chronically, especially if they have goiter or Hashimoto's thyroiditis.

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