SURGICAL-MANAGEMENT OF AMIODARONE-ASSOCIATED THYROTOXICOSIS - TOO RISKY OR TOO EFFECTIVE

Amiodarone-associated thyrotoxicosis, often clinically mild and resolu tive after amiodarone discontinuation or under medical therapy, is som etimes drug unresponsive and not uncommonly follows a dramatic, even f atal course. Therefore, we considered a surgical solution in 15 severe ly amiodarone-associated thyrotoxic patients. Twelve men and three wom en (mean age 68 years, range 50-84 years) underwent radical thyroidect omy for clinical and biologically proved amiodarone-associated thyroto xicosis. In six surgery was the first-line therapeutic option. In the other nine thyroidectomy seemed unavoidable considering the unresponsi veness to medical therapy and rapid deterioration of the patients' cli nical condition, with life-threatening cardiac failure in three. In ev ery patient surgery was conducted without immediate or delayed complic ations. Total thyroidectomy proved uniformly, definitively, and rapidl y effective in controlling thyrotoxicosis in all patients, with a spec tacular reversal of cardiac failure in the three most critical cases, Surgery was beneficial to our 15 patients and undoubtedly life-saving in the three most worrying cases. These results suggest that thyroidec tomy should be more liberally regarded as an interesting alternative t o conventional, but unpredictably effective, medical therapies.