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In their "Practical Guidelines for Clinicians Who Treat Patients With Amiodarone," Goldschlager et al¹ missed some important points on the effect of amiodarone on thyroid function. First, it seems important to recall that amiodarone inhibits the conversion of thyroxine to triiodothyronine, resulting in slightly but abnormally increased free thyroxine levels contrasting with normal thyrotropin concentrations in the majority of patients treated with amiodarone despite clinical euthyroidism.² Therefore, screening for thyroid dysfunction (reference 1, Table 2) requires only thyrotropin measurement in amiodarone-treated patients. Second, in Goldschlager and colleagues' Table 1, the incidence of hyperthyroidism is much lower than that of hypothyroidism in these patients. This is true in North America, not in Europe or other countries that have a suboptimal iodine supply. In Europe, amiodarone-induced hyperthyroidism (AIH) is more frequent than hypothyroidism, occurring in up to 10% of patients treated with amiodarone.³ In our experience, AIH accounts for 50% of severe . . . [Full Text of this Article]

RELATED ARTICLE

Practical Guidelines for Clinicians Who Treat Patients With Amiodarone
Nora Goldschlager, Andrew E. Epstein, Gerald Naccarelli, Brian Olshansky, Braman Singh, and for the Practice Guidelines Subcommittee, North American Society of Pacing and Electrophysiology
Arch Intern Med. 2000;160(12):1741-1748.
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