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The Effects of Amiodarone on Thyroid Function in Pediatric and Young Adult Patients.

CONTEXT
Amiodarone is used in patients with arrhythmias, but thyroid dysfunction (amiodarone-induced thyrotoxicosis (AIT) or amiodarone-induced hypothyroidism (AIH)) is a common adverse effect. As the onset of AIT and AIH have not been studied in children, the timing of dysfunction and long term monitoring are not known in this population.


OBJECTIVE
To describe the incidence and timing of amiodarone-induced thyroid dysfunction in children and adolescents with a secondary aim to identify risk factors for amiodarone-induced thyroid dysfunction; and to identify variance in thyroid hormone surveillance and treatment.


DESIGN
Retrospective review of thyroid dysfunction in children and young adults treated with amiodarone between 2007 and 2018.


SETTING
The Children's Hospital of Philadelphia.


PATIENTS
Children and young adults treated with amiodarone.


MAIN OUTCOME MEASURES
Prevalence of amiodarone-induced thyroid dysfunction.


RESULTS
Of 484 patients, 190 had thyroid function testing. 17.3% were found to have subclinical hypothyroidism and 13.7% testing developed hypothyroidism. Hyperthyroidism occurred in 2.1%. In patients with subclinical hypothyroidism, 63% returned to normal thyroid function without thyroid hormone replacement. Only 26% of patients with hypothyroidism had spontaneous normalization of thyroid function. 25% of AIT patients had spontaneous normalization of thyroid function.


CONCLUSIONS
This is the first study to look at a pediatric and young adult population in an effort to describe the natural history of amiodarone induced thyroid dysfunction. Based upon our data, we recommend that a complete thyroid function panel be obtained within the first week and then at weekly intervals for the first five weeks after initiation. The majority of thyroid dysfunction was noted within the first 35 days of treatment.