Amiodarone & Thyroid

[Guest guest]

Hi all, My husband has a mechanical aortic valve since 2003 hence he is on

200mgs Amiodarone plus Warfarin,Candesartan, Felodopine & 50mcg Levothyoxine due

to diminished thyroid function caused by Amiodarone. He has been on thyroxine

for about 2 years. Now yesterday we ended up in A & E via ambulance as he had a

very bad turn whilst we were sitting on the bus and his blood pressure was down

in his boots. He has suffered with high blood pressure probably for the last 25

years at least but lately it has been a bit too low and he needs to sort out his

hypertensive drugs. I am beginning to wonder if he could possibly be in need of

more thyroxine for his thyroid as his blood pressure is so low, he is always

cold, he sleeps alot, (always has done) and lots of other small symptoms that

could be connected. He says it's the Warfarin that makes him cold. I don't don't

know any of his thyroid test results which he does about twice a year. I am

guessing that they only do TSH but I'm going to see if I can get them from the

surgery. Apparently his heart valve is working fine and his ECG is the same as 5

years ago. I would like to know how exactly thyroid function is affected by

Amiodarone, is it at thyroid level or is it in the circulating blood or at

cellular uptake level? The more I think about it the more I wonder if a raise in

thyroxine might not help especially as he takes all his pills in one go in the

morning and 50mcg seems a low dose for an 85kg man. I can't get much sense out

of him and he is the typical man who doesn't question what the GP says and

thinks I am a fanatical hypochondriac and he gets that irritated bored

expression when I try to investigate his health.

[Guest guest]

Hi

Amiodarone can cause both thyrotoxicosis and hypothyroidism. Read

the information here which really goes into a lot of detail http://www.aacn.org/WD/CETests/Media/C0632.pdf

and which should answer some of your questions. Can I just say that your

husband should be grateful that he has somebody close to him that is taking a

keen interest in his health and is trying to do whatever is possible to help him.

He is very lucky.

Amiodarone apparently has a

very long half life of 7 to 8 weeks The amiodarone molecule is

structurally similar to T4 and contains 2 atoms of iodine per molecule.7 Amiodarone

is approximately 37% iodine by weight; hence each 200- mg tablet contains about

75 mg of iodine, of which approximately 10% is released as free iodine after

deiodination. In comparison, the reference daily intake of iodine for adults is

150 ìg.

An interesting phenomenon of the

effect of amiodarone-induced thyroid dysfunction is that the effect may range

from abnormal results on thyroid function studies without overt dysfunction to

symptomatic thyrotoxicosis or hypothyroidism.

Signs and symptoms of

alteration in thyroid function take longer to develop than do changes in serum

levels of thyroid hormones.  Typically, alterations in the concentrations of

circulating thyroid hormones occur within days after treatment with amiodarone

is started, and the alterations may change during the course of therapy. Almost

immediately, an increase occurs in the serum levels of total T4 and FT4.

The following is a list of drugs interactions with Amiodarone:

Drugs that may prolong the

QTc interval

Antiarrhythmic agents,

including quinidine, procainamide, sotalol

Antipsychotic agents,

including haloperidol, risperidone, quetiapine

Antinausea/antivomiting

agents such as dolasetron, droperidol

Azole antifungal agents

Erythromycin

Fluoroquinolones

Halothane

Macrolides

Moxifloxacin

Phenothiazines

Tricyclic antidepressants

Thiazide diuretics

Drugs that affect the metabolism of amiodarone

Cimetidine

HIV protease inhibitors

Rifampin

Drugs whose metabolism is affected by amiodarone

Inhibitors of

3-hydroxy-3-methylglutaryl coenzyme A (commonly called statins)

Phenytoin

Warfarin

Digoxin

Luv - Sheila

I would like to know how exactly thyroid function is

affected by Amiodarone, is it at thyroid level or is it in the circulating

blood or at cellular uptake level? The more I think about it the more I wonder

if a raise in thyroxine might not help especially as he takes all his pills in

one go in the morning and 50mcg seems a low dose for an 85kg man. I can't get

much sense out of him and he is the typical man who doesn't question what the

GP says and thinks I am a fanatical hypochondriac and he gets that irritated

bored expression when I try to investigate his health.

[Guest guest]

Thank you Sally for your reply. It set me looking up connection between thyroid

& heart valves and as far as I can see it is the Mitral valve that is sometimes

affected and my husband had an aortic valve replacement which leads me to

believe that he first had an aortic valve problem then an underactive thyroid

caused by the Amiodarone that he is prescribed. I have nagged him into doing as

he is told (by me) and his first basal temp. measurement is just 36.1. I'll get

him to do it for a few days and as he has a GP appointment tomorrow I'll see if

I can get some old thyroid blood test results. Thanks again....

>

>

>

> You are right to be concerned.  I would suggest it MAY have been a thyroid

problem that caused his heart valve issue?  I know this from my mum who was

hypothyroid after having four kids.  The fourth, my brother was born with

hypothyroidism and is slightly 'different'....He interestingly had a heart

attack in his thirties and has a dodgy valve.

>  

>

[Guest guest]

Hi Sheila, thank you, that is an interesting link you sent me. A bit on the

heavy side but I think I have got the gist of it and it'll get through ok if I

read it two or three times. He has been on Amiodarone 200mgs for about 8 years

and on 50mcg levothyroxine for about 2 years. When I manage to get his results

then I'll post them on here and perhaps you can see what you make of them in

relation to the fact he is on Amiodarone. Cheers

>

> Hi

>

> Amiodarone can cause both thyrotoxicosis and hypothyroidism. Read the

> information here which really goes into a lot of detail

> http://www.aacn.org/WD/CETests/Media/C0632.pdf and which should answer some

> of your questions. Can I just say that your husband should be grateful that

> he has somebody close to him that is taking a keen interest in his health

> and is trying to do whatever is possible to help him. He is very lucky.

>

>

>

[Guest guest]

Hubby needs to get his adrenals tested. details of an accurate test is in our files. I am experiencing low blood pressure also and mine is low adrenals.so don`t worry just order the test and it will pick up what the adrenals are doing. also taking the Early morning temps will help you understand things a bit better. look up Dr Rind. angel.

[Guest guest]

Well we have managed to get to the GP to discuss his trip to A & E and I went in

with my husband and also asked about raising his Thyroxine but she said she

would rather check his thyroid levels again (it's been about 3 or 4 months since

his last check). She even suggested he might have Hashimoto's so I pushed for

the antibodies check. I got the last blood test results (didn't want to push my

luck and ask for more especially as we are doing another test in a couple of

days) which were...TSH 2.44 (0.3-4.2) T4 19.7(12-22). His early morning temps so

far orally are about 35.8/36.1. I'm thinking that the TSH is a bit high for a T4

of 19.7. Should he not take the 50mcg thyroxine the morning before his blood

test. Thanks.........

>

> Hi all, My husband has a mechanical aortic valve since 2003 hence he is on

200mgs Amiodarone plus Warfarin,Candesartan, Felodopine & 50mcg Levothyoxine due

to diminished thyroid function caused by Amiodarone. He has been on thyroxine

for about 2 years.

[Ed]

[Guest guest]

Yes is the answer to your question "Should he not take the 50mcg thyroxine the morning OF his blood test." I say YES because of the way you worded your question.

So If you ask should my husband take thyroxine the morning of his blood test I would answer NO he shouldnt.

Take it as soon as practicable after the blood test has been carried out.

Well we have managed to get to the GP to discuss his trip to A & E and I went in with my husband and also asked about raising his Thyroxine but she said she would rather check his thyroid levels again (it's been about 3 or 4 months since his last check). She even suggested he might have Hashimoto's so I pushed for the antibodies check. I got the last blood test results (didn't want to push my luck and ask for more especially as we are doing another test in a couple of days) which were...TSH 2.44 (0.3-4.2) T4 19.7(12-22). His early morning temps so far orally are about 35.8/36.1. I'm thinking that the TSH is a bit high for a T4 of 19.7. st. Thanks.........>> Hi all, My husband has a

mechanical aortic valve since 2003 hence he is on 200mgs Amiodarone plus Warfarin,Candesartan, Felodopine & 50mcg Levothyoxine due to diminished thyroid function caused by Amiodarone. He has been on thyroxine for about 2 years. [Ed]

[Guest guest]

Thank you Sally....

> >

> > Hi all, My husband has a mechanical aortic valve since 2003 hence he is on

200mgs Amiodarone plus Warfarin,Candesartan, Felodopine & 50mcg Levothyoxine due

to diminished thyroid function caused by Amiodarone. He has been on thyroxine

for about 2 years.

>

> [Ed]

>