Rate of guideline consistent monitoring of thyroid stimulating hormone and liver function test in patients on long term amiodarone treatment.
Shakaroun D. Rate of guideline consistent monitoring of thyroid stimulating hormone and liver function test in patients on long term amiodarone treatment. Thyroid 2018; 28:A116-A117.
Long term amiodarone treatment can lead to thyroid dysfunction as well as hepatic toxicity. Amiodarone-induced thyroid dysfunction can occur in about 32% of treated patients. Thus, periodic monitoring of thyroid stimulating hormone (TSH) and liver function tests (SGPT and SGOT) is recommended. However, data is limited regarding rates of adherence to guidelines. Using an urban center population, we aimed to characterize the patient population with long-term amiodarone use and assess rates of adherence to current guidelines for TSH, SGPT and SGOT monitoring. All patients aged 18 years or older who were prescribed amiodarone for more than 1 year in Henry Ford Hospitals, Detroit and West Bloomfield, Michigan were retrospectively identified between January 2013 and December 2017. Patients younger than 18 years and those who had amiodarone prescribed for less than 3 months were excluded. The medical records were examined for patient's characteristics including age, gender and race. Patients prescribed amiodarone were also analyzed for adherence with established guidelines, defined as TSH measurement at time of amiodarone initiation and 3-6 months after. Adherence to liver function tests monitoring was also monitored at time of initiation of treatment and 6months after. Indication of amiodarone use, prescribers of amiodarone and TSH, concomitant statin use were also analyzed. A total of 295 patients were included in the study. The majority of these patients were males ( 62%) and white (50%) with average age of 69.9. Amiodarone was prescribed for atrial fibrillation/flutter in 79% of the cases and ventricular arrhythmias in 19%. 73% of the patients used amiodarone concomitantly with statin. Amiodarone was prescribed mainly by cardiologists (75%) and TSH was prescribed by cardiologists (50%), primary care physicians (35%), cardiac surgeons (3%) and endocrinologists (3%). Baseline testing of TSH was done in 71% whereas baseline testing of SGPT and SGLT was at 12.5 %. At 3-6 months, only 51% had thyroid function tests and 9 % had liver function tests. Monitoring of thyroid and liver function tests in patients on amiodarone is less than optimal. This is probably due to lack of awareness of current guidelines.