Drug-Induced Thyroiditis


  • Several drugs have been reported to cause a drug-induced thyroiditis:
    • Amiodarone
    • Interferon-alfa
    • Interleukin-2
    • Lithium:
      • Lithium has been reported to cause a non destructive thyroiditis:
        • Similar to sporadic silent thyroiditis.
    • Minocycline
  • The clinical course of the drug induced thyroiditis is similar to the other forms of destructive thyroiditis:


  • Importantly:
    • Patients on the offending drugs may also develop:
      • Subacute, sporadic, or suppurative thyroiditis:
        • So these diagnoses need to be evaluated before ascribing the thyroiditis to a drug.
  • The thyroid abnormalities usually resolve with discontinuation of the offending drug.
  • Two drugs that deserve special mention are amiodarone and interferon-alfa:
    • Amiodarone:
      • An iodine-rich drug used in the treatment of cardiac arrhythmias:
        • Is well recognized to produce thyrotoxicosis by two forms:
          • Iodine-induced hyperthyroidism (type I)
          • Destructive thyroiditis (type II)
      • Distinguishing between the two forms is often a diagnostic dilemma:
        • And occasionally both forms may be present in the same patient.
      • In general:
        • Type II amiodarone-induced thyrotoxicosis occurs in:
          • A previously normal thyroid
          • The 24 RAIU is completely suppressed
          • Color flow Doppler ultrasonography shows absent vascularity.
      • The thyrotoxicosis usually responds to:
        • High doses of prednisone (40 to 60 mg daily):
          • Consistent with the underlying inflammatory process.
        • In all cases of amiodarone-induced thyrotoxicosis:
          • The drug should be discontinued if at all possible.
    • Interferon-alpha:
      • Is an immunomodulatory drug that is used in a variety of clinical conditions:
        • Most commonly in the treatment of viral hepatitis.
      • Up to 70% of patients without previous thyroid autoimmunity will develop:
        • High serum thyroid peroxidase antibody concentrations during interferon therapy.
      • Like amiodarone; two forms of interferon-induced thyrotoxicosis have been described:
        • A Graves’-like hyperthyroidism
        • A destructive thyroiditis
      • Frequently:
        • The thyrotoxicosis is mild and symptomatic therapy is often all that is necessary.
      • Because treatment with interferon-alpha is for a defined period:
        • The drug usually can be continued to finish the course of therapy when thyroid dysfunction develops.
        • Thyroid function usually normalizes after the interferon is stopped:
          • However, affected patients are at increased risk for autoimmune thyroid dysfunction in the future

#Arrangoiz #CancerSurgeon #ThyroidSurgeon #ParathyroidSurgeon #HeadandNeckSurgeon #ThyroidExpert #SurgicalOncologist #EndocrineSurgery #MountSinaiMedicalCenter #Miami #ThyroidNodule #ToxicNodularGoiter #TNG #MultinodularGoiter #GravesDisease #Hyperthyroidism #Goiter #DrugInducedThyroiditis

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