Amiodarone-associated thyreopathy in children with arrhythmias

Aim: To assess the indices of hormonal thyroid state during prolonged amiodarone therapy in children with arrhythmias at the ages from 0 to 7 years. 42 patients with WPW syndrome (n=19), atrial tachycardias (n=16), and ventricular tachycardias (n=7) received amiodarone therapy. The duration of amiodarone intake varied from 0.7 to 24 months (Me 6.00; IQR 1.83-9.00). The course of thyroid state was assessed in the following sequence: initially, during the prolonged treatment by amiodarone, but not earlier than in a month after the therapy started, and in 6 months after amiodarone withdrawal. Increases in thyroid stimulating hormone (TSH), thyroxine (total and free), and thyroglobulin as well as moderate decrease in triiodothyronine were demonstrated in the presence of amiodarone. The increases in total and free thyroxine (p=0.043 and p=0.037 correspondingly) were statistically significant. Statistically insignificant was the increase of TSH and thyroglobulin on amiodarone therapy. However, the decreases in the given indices were significant (p=0.006 and p=0.036 correspondingly) 6 months after amiodarone withdrawal. The comparison of initial indices with the results of their analysis 6 months after amiodarone withdrawal did not show any statistically significant differences. It should be noted that the clinical sings accompanying hypertyrosinemia during amiodarone therapy were not observed in our patients. The most significant changes of the thyroid state were discovered in infants. It should be noted that, the median indices did not go beyond reference range at all stages of amiodarone treatment including also their statistically significant changes at the peak of the therapy. Amiodarone-induced changes of thyroid state were of reversible nature and normalized 6 months after the therapy withdrawal.

тахиаритмии, дети, амиодарон, тиреопатии, tachyarrhythmias, children, amiodarone, thyreopathy

1. Сердюк С.Е., Бакалов С.А., Голицын С.П. и др. Частота возникновения и предикторы развития дисфункций щитовидной железы, вызванных длительным приемом амиодарона // Тер. архив. - 2005. - Т. 77, № 10. - С. 33-39

2. Свириденко Н.Ю., Платонова, Н.В., Молашенко Н.М. и др. Эндокринные аспекты применения амиодарона в клинической практике (Алгоритм наблюдения и лечения функциональных расстройств щитовидной железы) // Рос. кардиол. журнал. - 2012. - № 2. - С. 63-71.

3. Iervasi G., Clerico A., Bonini R. et al. Acute effects of amiodarone administration on thyroid function in patients with cardiac arrhythmia // J. Clin. Endocrinol. Metab. - 1997. - Vol. 82. -P. 275-280.

4. Bogazzi F., Tomisti L., Bartalena L. et al. Amiodarone and the thyroid: a 2012 update // J. Endocrinol. Invest. - 2012. -Vol. 35, No. 3. - P. 340-348.

5. Newman C., Price A., Davies D. et al. Amiodarone and the thyroid: a practical guide to the management of thyroid dysfunction induced by amiodarone therapy // Heart. - 1998. - Vol. 79. -P. 121-127.

6. Shahar E., Barzilay Z., Frand M. et al. Amiodarone in control of sustained tachyarrhythmias in children with Wolff-Parkinson-White syndrome // Pediatrics. - 1983. - Vol. 72. - P. 813-816.

7. Costigan D.C., Holland F.J., Daneman D. et al. Amiodarone therapy effects on childhood thyroid function // Pediatrics. -1986. - Vol. 77, No. 5. - P. 703-708.

8. Ardura J., Hermoso F., Bermejo J. Effect on growth of children with cardiac dysrhythmias treated with amiodarone // Pediatric Cardiology. - 1988. - Vol. 9. - P. 33-36.

9. Bogazzi F., Bartalena L., Tomisti L. et al. Continuation of amiodarone delays restoration of euthyroidism in patients with type 2 amiodarone-induced thyrotoxicosis treated with prednisone: a pilot study // J. Clin. Endocrinol. Metab. - 2011. - Vol. 96, No. 11. - P. 3374-3380.

10. Coumel P., Fidelle J. Amiodarone in the treatment of cardiac arrhythmias in children: one hundred thirty-five cases // Am. Heart J. - 1980. - Vol. 100. - P. 1063-1069.

11. Ahmed S., van Gelder I., Wiesfeld A. et al. Determinants and outcome of amiodarone-associated thyroid dysfunction // Clin. Endocrinol. (Oxf). - 2011. - Vol. 75, No. 3. - P. 388-394.

12. Bahn R., Burch H., Cooper D. et al. Hyperthyroidism and other causes of thyrotoxicosis: Management guidelines of the American Thyroid Association and American Association of Clinical Endocrinologists // Thyroid. - 2011. - Vol. 21. - P. 593-646.

13. Loh K. Amiodarone-induced thyroid disorders: a clinical review // Postgrad. Med. J. - 2000. - Vol. 76. - P. 133-140.

14. Olin B.R. Amiodarone // Drug facts and comparisons. - St. Louis: Facts and Comparisons, 2001. - P. 431-436.

15. Padmanabhan H. Amiodarone and thyroid dysfunction // South. Med. J. - 2010. - Vol. 103. - P. 922-930.

16. Paul T., Guccione P. New antiarrhythmic drugs in pediatric use: amiodarone // Pediatr. Cardiol. - 1994. - Vol. 15. - P. 132-138.

17. Zurakowski D., Canzio J.D., Majzpoub J.A. et al. Pediatric reference intervals for serum thyroxine, triiodothyronine, thyrotropin, and free thyroxine // Clin. Chem. - 1999. -Vol. 45. - P. 1087-1091.

18. Brugada J., Blom N., Sarquella-Brugada G. et al. Pharmacological and non-pharmacological therapy for arrhythmias in the pediatric population: EHRA and AEPC-Arrhythmia Working Group joint consensus statement // Europace. - 2013. -Vol. 15. - P. 1337-1382.

19. Djemli A., Vliet G.V., Belgoudi J. et al. Referance intervals for free thyroxine, total triiodthyronine, thyrotropin and thyroglobulin for Quebec newborns, chidren and teenagers // Clinical Biochemistry. - 2004. - Vol. 37. - P. 328-330.

20. Trudel K., Sanatani S., Panagiotopoulos C. Severe amiodarone-induced hypothyroidism in an infant // Pediatr. Crit. Care Med. - 2011. - Vol. 12. - P. 43-45.