ATA Guidelines Tools

28 Other Conditions Drug-Associated Thyrotoxicosis (cont'd) 109. Patients taking medications known to cause thyrotoxicosis, including interferon-α, IL-2, tyrosine kinase inhibitors, and lithium, should be monitored clinically and biochemically at 6-month intervals for the development of thyroid dysfunction. Patients who develop thyrotoxicosis should be evaluated to determine etiology and treated accordingly. (S-L) Iodine-induced Hyperthyroidism 110. Routine administration of ATDs before iodinated contrast media exposure is not recommended for all patients. (W-L) 111. Beta-adrenergic blocking agents alone or in combination with MMI should be used to treat overt iodine-induced hyperthyroidism. (S-L) Amiodarone-induced Thyrotoxicosis (AIT) 112. The ATA suggests monitoring thyroid function tests before and within the first 3 months following the initiation of amiodarone therapy, and at 3–6 month intervals thereafter. (W-L) 113. The decision to stop amiodarone in the setting of thyrotoxicosis should be determined on an individual basis in consultation with the treating cardiologist, based on the clinical manifestations and presence or absence of effective alternative antiarrhythmic therapy. (S-L) 114. In clinically stable patients with AIT, the ATA suggests measuring thyroid function tests to identify disorders associated with iodine- induced hyperthyroidism (type 1 AIT), specifically including toxic nodular disease and previously occult GD. (S-L) 115. MMI should be used to treat overt thyrotoxicosis in patients with proven underlying autonomous thyroid nodules or GD as the cause of amiodarone-induced thyrotoxicosis (type 1 disease), and corticosteroids should be used to treat patients with overt amiodarone-induced thyroiditis (type 2 disease). (S-L) 116. Combined ATD and corticosteroid therapy should be used to treat patients with overt amiodarone-induced thyrotoxicosis who are too unstable clinically to allow a trial of monotherapy, or who fail to respond to single modality therapy, or patients in whom the etiology of thyrotoxicosis cannot be unequivocally determined. (S-L) 117. Patients with AIT who are unresponsive to aggressive medical therapy with MMI and corticosteroids should undergo thyroidectomy. (S-L)

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