• Amiodarone can cause either a destructive thyroiditis or a pattern of thyrotoxicosis quite similar to autoimmune hyperthyroidism. If it is primarily a destructive thyroiditis then steroid therapy is useful to control the situation.
• Amiodarone induced thyroid dysfunction can occur even in those who have discontinued amiodarone up to 18 months previously
• Following the baseline blood test, we would recommend commencing Prednisolone 40mg daily and Carbimazole 40mg daily with the usual BNF warnings. In particular, due to the small risk of agranulocytosis, the importance of checking a full blood count in the event of significant sore throat, unexplained fever or mouth ulcers must be stressed. If there is any history of gastritis please commence PPI or ranitidine to reduce the risk of this with the steroid therapy
• Total T3 should be checked prior to and 2 weeks after commencement of steroids as this is vital in differentiating the response.
• We would not recommend discontinuing amiodarone without first discussing with the cardiologists.
• Please re-check thyroid functions including a baseline TSH, free T3 and free T4 and in 2 weeks time. Please also check thyroid peroxidise antibodies (TPO) and anti TSH receptor (thyrotropin receptor (TRAb) antibody

We aim to review people with amiodarone induced thytrotoxicosis within 3 weeks of referral and usually if FT3 improves by 50% with 2 weeks of therapy – steroids will usually be continued preferentially and carbimazole may be discontinued.

The tests and results above will help guide our treatment plan and allow efficient use of clinic appointments

Patient information leaflets can be found on the British Thyroid Foundation website (http://www.btf-thyroid.org/). There are leaflets on a number of topics related to over-active thyroids.