potassium-perchlorate and Hyperthyroidism

TWO TYPES: Hyperthyroidism may develop in around 10% of patients in excess iodine. It may reveal an undetected pretoxic thyroid disease (type I) or have been induced by excess iodine in previously normal thyroid gland or in an euthyroid goiter (type II). IODINE EXCESSE REVEALING THYROTOXICOSIS: In the former situation, symptoms appear shortly after the iodine load, thyroid scintigraphy shows significant uptake and therapy includes discontinuation of iodine excess, antithyroid drugs, potassium perchlorate and, if necessary, thyroidectomy or a therapeutic dose of iodide 131. IODINE-INDUCED THYROTOXICOSIS: In the latter situation (type II) hyperthyroidism may occur several years after the initiation of iodine excess, scintigraphy shows very low or no uptake, spontaneous remission is observed within six months, despite the persistence of iodine excess, and treatment is based on corticosteroids.

Topics: Antithyroid Agents; Follow-Up Studies; Humans; Hyperthyroidism; Iodine; Perchlorates; Potassium Compounds; Risk Factors; Thyroid Diseases; Thyroid Function Tests; Thyroidectomy; Thyrotoxicosis

We report 11 cases of amiodarone-induced hyperthyroidism. We tried to classify them into 2 groups, according to Bartelena et al. (JCEM 81: 2930, 1996). The serum level of interleukin-6 (IL-6) was measured in 7 patients by an immunoenzymometric assay. In type I (cases 1-3) the thyroid was abnormal (goiter, Graves' disease) but IL-6 levels were normal. These cases were successfully managed by the combined use of thionamide drugs (carbimazol or propylthioruacil = PTU) and potassium perchlorate. In type II (case 4), the thyroid seemed to be normal but the serum level of IL-6 was increased, possibly due to a destructive thyroiditis. Treatment with prednisone (40 mg/day) and PTU resulted in a prompt normalization of T3. Contrary to Bartalena et al., we observed cases with normal thyroid and normal levels of IL-6 (cases 5-8) (type III). In these cases prednisone (40 mg/day for 2 weeks) was ineffective but the combined use of thionamide drugs and perchlorate was associated with a normalization of thyroid hormones. This combined treatment seems to be effective in most patients (type I, III). In case of failure of this treatment, a high dose of prednisone (1 mg/kg) could be tried or a lower dosage (40 mg/day) could be used in cases with high IL-6 levels (type II).

Topics: Adult; Aged; Aged, 80 and over; Amiodarone; Anti-Arrhythmia Agents; Anti-Inflammatory Agents; Antithyroid Agents; Child; Drug Monitoring; Drug Therapy, Combination; Female; Humans; Hyperthyroidism; Interleukin-6; Male; Middle Aged; Patient Selection; Perchlorates; Potassium Compounds; Prednisone

Hypothyroidism followed by hyperthyroidism is described in two patients treated by amiodarone. Euthyroidism was rapidly restored after treatment with antithyroid drugs and potassium perchlorate. The physiopathology of amiodarone-induced hypothyroidism is discussed. Withdrawal of amiodarone is advised in the case of both hypothyroidism and hyperthyroidism.

Topics: Aged; Aged, 80 and over; Amiodarone; Antithyroid Agents; Female; Humans; Hyperthyroidism; Hypothyroidism; Male; Middle Aged; Perchlorates; Potassium Compounds

To exploit the antiarrhythmic effect of amiodarone when patients develop the side effect of thyrotoxicosis three patients with hyperthyroidism induced by amiodarone were given simultaneously 1 g potassium perchlorate a day for 40 days and a starting dose of 40 mg methimazole a day while they continued to take amiodarone. As hyperthyroidism might have recurred after potassium perchlorate treatment was stopped the dose of methimazole was not reduced until biochemical hypothyroidism (raised thyroid stimulating hormone concentrations) was achieved. The patients became euthyroid (free triiodothyronine concentration returned to normal values) in two to five weeks and hypothyroid in 10 to 14 weeks. One patient became euthyroid while taking 5 mg methimazole a day and 600 mg amiodarone weekly; the two others required substitution treatment with thyroxine sodium while taking 5 mg methimazole or 50 mg propylthiouracil (because of an allergic reaction to methimazole) and 2100 or 1400 mg amiodarone weekly. Hyperthyroidism induced by amiodarone may be treated with potassium perchlorate and methimazole given simultaneously while treatment with amiodarone is continued.

Topics: Aged; Amiodarone; Arrhythmias, Cardiac; Drug Evaluation; Drug Therapy, Combination; Humans; Hyperthyroidism; Methimazole; Middle Aged; Perchlorates; Potassium; Potassium Compounds; Thyroid Gland

In order to assess the value of thyroid function testing during amiodarone therapy, we reviewed all available tests in 128 patients treated with this drug. Nine patients (7.0%) developed biochemical hyperthyroidism with elevation of both free thyroxine index (FT4I) and free triiodothyronine index (FT3I) and marked suppression of serum thyroid stimulating hormone (TSH) after 1-46 months of therapy; six of these nine patients had clear clinical evidence of thyroid overactivity. Where serial tests were available before development of hyperthyroidism, this complication developed suddenly, despite previously stable normal indices of thyroid function, and could not be predicted by currently-available biochemical tests such as T4, T3, sensitive TSH, thyroglobulin or sex hormone binding globulin (SHBG) assays. Clinical features such as unexplained weight loss, proximal myopathy, exacerbation of arrhythmia, or heat intolerance appear to be the key to prompt diagnosis of this complication. Hyperthyroxinemia without T3 excess was found in 32.8% of patients without progression to true hyperthyroidism. Serum TSH remained detectable by sensitive assay in 17 out of 18 patients with amiodarone-induced euthyroid hyperthyroxinemia and was significantly higher than in patients with equivalent hyperthyroxinemia due to thyroxine therapy. Serial levels of SHBG were higher in patients with true hyperthyroidism than in those with euthyroid hyperthyroxinemia. The effect of combined treatment with propylthiouracil (800 mg/day) and potassium perchlorate (800 mg/day) was evaluated in five of the six clinically hyperthyroid patients. Biochemical euthyroidism was achieved after 7-19 weeks, a response slower than previously reported, indicating that this drug combination does not result uniformly in prompt resolution of amiodarone-induced hyperthyroidism.

Topics: Adolescent; Adult; Aged; Amiodarone; Child; Drug Therapy, Combination; Female; Humans; Hyperthyroidism; Male; Middle Aged; Perchlorates; Potassium; Potassium Compounds; Predictive Value of Tests; Propylthiouracil; Sex Hormone-Binding Globulin; Thyroglobulin; Thyroid Function Tests; Thyrotropin; Thyroxine

Topics: Drug Therapy, Combination; Female; Humans; Hyperthyroidism; Iodine; Middle Aged; Perchlorates; Potassium; Potassium Compounds; Propylthiouracil

Topics: Adult; Amiodarone; Female; Glucocorticoids; Humans; Hyperthyroidism; Hypothyroidism; Male; Perchlorates; Plasmapheresis; Potassium; Potassium Compounds; Propylthiouracil; Thyroid Hormones; Thyroidectomy; Thyroxine

Topics: Amiodarone; Humans; Hyperthyroidism; Male; Middle Aged; Perchlorates; Potassium; Potassium Compounds; Propylthiouracil

Topics: Humans; Hyperthyroidism; Mental Disorders; Perchlorates; Potassium; Potassium Compounds; Psychoses, Substance-Induced; Psychotic Disorders

Topics: Antithyroid Agents; Goiter; Graves Disease; Humans; Hyperthyroidism; Perchlorates; Potassium; Potassium Compounds

Topics: Anemia, Aplastic; Antithyroid Agents; Drug Hypersensitivity; Geriatrics; Humans; Hyperthyroidism; Penicillins; Perchlorates; Potassium; Potassium Compounds; Sulfonamides; Thyrotoxicosis; Toxicology

Topics: Antithyroid Agents; Hyperthyroidism; Perchlorates; Potassium Compounds

Topics: Antithyroid Agents; Humans; Hyperthyroidism; Perchlorates; Potassium Compounds; Thyrotoxicosis

Topics: Disease Management; Humans; Hyperthyroidism; Perchlorates; Potassium Compounds; Thyrotoxicosis

Topics: Anemia; Anemia, Aplastic; Humans; Hyperthyroidism; Perchlorates; Potassium Compounds; Thyrotoxicosis

Topics: Antithyroid Agents; Exophthalmos; Hyperthyroidism; Perchlorates; Potassium Compounds; Thyrotoxicosis; Thyroxine

Topics: Hyperthyroidism; Perchlorates; Potassium Compounds; Thyrotoxicosis

Topics: Anemia; Anemia, Aplastic; Humans; Hyperthyroidism; Perchlorates; Potassium Compounds

Topics: Anemia, Aplastic; Humans; Hyperthyroidism; Perchlorates; Potassium Compounds; Thyrotoxicosis

Topics: Antineoplastic Agents, Hormonal; Antithyroid Agents; Hyperthyroidism; Perchlorates; Potassium Compounds; Uracil

Topics: Antineoplastic Agents, Hormonal; Antithyroid Agents; Carbimazole; Humans; Hyperthyroidism; Methylthiouracil; Perchlorates; Potassium Compounds; Thiouracil; Thyrotoxicosis

Topics: Hyperthyroidism; Perchlorates; Potassium; Potassium Compounds; Thyrotoxicosis

Topics: Hyperthyroidism; Perchlorates; Potassium; Potassium Compounds; Thyrotoxicosis

Topics: Antithyroid Agents; Hyperthyroidism; Perchlorates; Potassium Compounds

Topics: Antithyroid Agents; Carbimazole; Hyperthyroidism; Perchlorates; Potassium Compounds

Topics: Antithyroid Agents; Hyperthyroidism; Perchlorates; Potassium Compounds

Topics: Hyperthyroidism; Perchlorates; Potassium; Potassium Compounds; Thyrotoxicosis

Topics: Hyperthyroidism; Perchlorates; Potassium; Potassium Compounds; Tyrosine

Topics: Hyperthyroidism; Perchlorates; Potassium Compounds

Topics: Hyperthyroidism; Nutrition Therapy; Perchlorates; Potassium; Potassium Compounds

Topics: Antineoplastic Agents, Hormonal; Antithyroid Agents; Hyperthyroidism; Perchlorates; Potassium Compounds; Thyrotoxicosis

Topics: Chlorine; Hyperthyroidism; Perchlorates; Potassium Compounds; Thyrotoxicosis

Topics: Chlorine; Hyperthyroidism; Perchlorates; Potassium Compounds; Thyrotoxicosis

Topics: Antithyroid Agents; Chlorine; Hyperthyroidism; Perchlorates; Potassium Compounds

Topics: Antithyroid Agents; Catechols; Chlorine; Hyperthyroidism; Perchlorates; Potassium Compounds

Topics: Humans; Hyperthyroidism; Perchlorates; Potassium; Potassium Compounds

Topics: Adolescent; Child; Humans; Hyperthyroidism; Infant; Perchlorates; Potassium; Potassium Compounds; Thyrotoxicosis

Topics: Hyperthyroidism; Perchlorates; Potassium; Potassium Compounds; Reserpine; Thyrotoxicosis

Topics: Hyperthyroidism; Perchlorates; Potassium; Potassium Compounds

Topics: Chlorine; Hyperthyroidism; Ions; Perchlorates; Potassium; Potassium Compounds

Topics: Hyperthyroidism; Perchlorates; Potassium; Potassium Compounds; Thiouracil; Thyrotoxicosis

Topics: Hyperthyroidism; Perchlorates; Potassium; Potassium Compounds; Thyroid Crisis

Topics: Hyperthyroidism; Perchlorates; Potassium; Potassium Compounds

Topics: Hyperthyroidism; Perchlorates; Potassium; Potassium Compounds

Topics: Chlorine; Hyperthyroidism; Perchlorates; Potassium; Potassium Compounds; Thyrotoxicosis

Topics: Hyperthyroidism; Perchlorates; Potassium; Potassium Compounds; Thyrotoxicosis