Surgical management of amiodarone-associated thyrotoxicosis.

LESSONS FROM PRACTICE AMIODARONE is used in the management of cardiac dysrhythmias. Accumulation of amiodarone in the thyroid gland may result in thyroid dysfunction, either hypothyroidism or thyrotoxicosis.1 Amiodarone-associated thyrotoxicosis (AAT) occurs in about 3% of patients.2 In some patients, cessation of amiodarone is not practical, as it may be the only effective anti-arrhythmic agent. Furthermore, cessation of amiodarone may be followed by a rebound rise in tri-iodothyronine, which worsens the thyrotoxic state.3,4 Even when amiodarone can be discontinued, AAT can take up to nine months to resolve. Medical management may be ineffective and can result in complications, or sometimes death.5 In these very difficult situations, surgery has an important role. In the past it was thought that the risk of thyroid storm and the risks associated with anaesthesia would preclude surgery. However, recent experience has demonstrated that surgery may be performed safely and successfully, as illustrated in the case reports summarised in Box 1.