Use of oral cholecystographic agents in the treatment of amiodarone-induced hyperthyroidism

We describe here five cardiac patients with type II amiodarone-induced hype rthyroidism who were treated prospectively with a combination of an oral ch olecystographic agent (sodium ipodate, Oragrafin, or sodium iopanoate, Tele paque) and a thionamide (propylthiouracil or methimazole); amiodarone was d iscontinued in all patients, All patients improved substantially clinically within a few days of treatment and became euthyroid or hypothyroid in 15-3 1 wk when treatment was discontinued. Four of the five became hypothyroid a nd required long-term treatment with L-T-4; the remaining patient was euthy roid, but died from cardiomyopathy and congestive heart failure at 29 wk, w hen he had been off oral cholecystographic agent and thionamide for 6 wk. W e did not find any clinical or biochemical adverse effects of the treatment . Our study suggests that a combination of oral cholecystographic agent and thionamide is a safe and effective treatment of type II amiodarone-induced hyperthyroidism. Data also suggest that hypothyroidism is a common end res ult of type II amiodarone-induced hyperthyroidism.