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Amiodarone and Thyroid Function
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
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•Type with double-spacing
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Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
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TO THE EDITOR:
In reviewing the effects of amiodarone on thyroid physiology, Harjai and Licata [1] state that amiodarone “decreases the peripheral deiodination of thyroxine to triiodothyronine … resulting in an increase of serum levels of thyroxine and reverse triiodothyronine and a decrease of serum levels of triiodothyronine (by 20% to 25%), as seen in the euthyroid sick syndrome.” However, in discussing treatment options for amiodarone-induced hypothyroidism, they recommend replacement therapy with levothyroxine. Perhaps we have blinders on about the potential advantages of replacement therapy using triiodothyronine or a combination of triiodothyronine and thyroxine.
In clinical practice, I have seen good results with triiodothyronine or triiodothyronine and thyroxine in patients with generalized illness, clinical hypothyroidism, elevated thyroid-stimulating hormone levels, normal free thyroxine levels, and low free triiodothyronine levels, consistent with defective peripheral deiodination. Of note, many of these patients did not tolerate replacement therapy with levothyroxine alone, often because of palpitations, anxiety, or other side effects consistent with overreplacement, despite persistent elevations of thyroid-stimulating hormone levels.
James R. Biddle, MD
Carolina Center for Metabolic Medicine; Asheville, NC 28801
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
