ACTA ENDOCRINOLOGICA (BUC)

Background. In most type 1 and mixed forms of amiodarone-induced thyrotoxicosis (AIT), after restoration of euthyroidism and whether amiodarone can be withdrawn, an ablative therapy (thyroidectomy or radioiodine) is required. Radioiodine ablation of the thyroid was reported to prevent recurrence of AIT after amiodarone reintroduction.\r\nAims. To assess the efficacy and safety of radioiodine treatment in type 1 and mixed forms of AIT.\r\nPatients and methods. 9 patients (6M/3F) with type 1 and mixed form of AIT, mean age 62.2 ? 13.3 years (range: 50-85 years), pretreated with methimazole, received radioiodine treatment. The underlying thyroid disease was Graves disease (n= 5), toxic multinodular goiter (n= 3) and toxic adenoma (n=1). TSH, total T3, total T4, free T4, TPOAb were measured by radioimmunoassay; radioiodine uptake, thyroid ultrasonography, color flow Doppler ultrasonography were performed.\r\nResults. Multiple radioiodine doses were required in 4 out of 9 patients. Pretreatment 24 hours radioiodine uptake exceeded 10% in 12 out of 16 doses. Mean cumulative dose was 23.17 ? 17.48 mCi 131I (range 6-50 mCi). The period between amiodarone withdrawal and 131I administration was 11.72 ? 12.45 months (range: 2-41 months). Mean cumulative 131I dose was higher in AIT due to toxic multinodular goiter and toxic adenoma (30.25 ? 20.09, range: 11-50 mCi) versus Graves disease (17.5 ? 14.76, range: 6.5-40 mCi). In one patient with toxic adenoma, thyroidectomy was contraindicated due to a comorbidity-central core disease - a non-progressive congenital myopathy, associated with an increased risk for malignant hyperthermia. Hypothyroidism occurred in all patients but one (euthyroid), within 14 ? 3 months (range: 5-27) after the first radioiodine dose. Sinus rhythm was restored in 3 out of 5 patients. One case of radiation thyroiditis occurred after a single 6.5 mCi 131I dose.\r\nConclusion. Radioiodine ablation therapy is an effective and safe alternative in patients with type 1 and mixed forms of amiodarone-induced thyrotoxicosis. Since amiodarone should need sometimes to be restarted, post radioiodine hypothyroidism should be viewed as a goal rather than a complication.

The aim of our prospective study is to determine the prevalence of autoimmune thyroiditis (AIT), sub clinical hypothyroidism and metabolic syndrome in patients with polycystic ovary syndrome (PCOS). Twenty-five patients with PCOS (according to Rotterdam ESHRE/ASRM criteria) aged between 20-35 years, hospitalised in the Institute of Endocrinology between January 2004 and December 2006 were selected to evaluate thyroid morphology, function and immunologic status, and were compared with a control group of 20 women without PCOS. All subjects were clinically examined (BMI, blood pressure, hirsutism) and evaluated for LH/FSH ratio, E2, P, PRL, free testosterone, TSH, TPOA, HOMA-IR, fasting glycaemia, lipid metabolism. Thyroid ultrasonography was performed with a multiple&#8211;frequency linear transducer in grey scale and colour Doppler mode. Ultrasound transvaginal examination of the ovary was also performed. Patients with PCOS had LH/FSH ratio > 2, free testosterone > 0.95 ? 0.2 mMol/L, 15 patients had TSH > 4.5 mUI/L (60 %. p < 0.001) and 7 (28 %) had high levels of TPOA. In the control group TSH and TPOA were normal. Thyroid ultrasound showed total thyroid volume of 16.54?1.80 cm3 in 60 % of patients with PCOS and 10.51 ? 1.20 cm3 in the control group. Hypoechogenic areas were present in 60 % of patients with PCOS and absent in the control group. 15 (60 %) of the patients with PCOS had insulin resistance (HOMA&#8211;IR > 3.3?1.2 mU x mMol/L), and 16 (16 %, p<0.001) had hyperlipoproteinemia. In the control group one case has hypercholesterolemia. In conclusion, this demonstrates that autoimmune thyroiditis is frequent in patients with PCOS and indicates a potential cardiovascular risk due to the association of sub clinical hypothyroidism, dislipidemia and insulin resistance and suggests that patients with PCOS should be screened for thyroid function and morphology.