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AMİODARONA BAĞLI TİROTOKSİKOZDA TANI YÖNTEMLERİ VE TEDAVİ SEÇENEKLERİNİN RETROSPEKTİF DEĞERLENDİRİLMESİ

Year 2023, Volume: 86 Issue: 3, 227 - 234, 26.10.2023

Nezahat Müge Çatıkkaş Hülya Hacişahinoğulları Nurdan Gül Özlem Soyluk Selçukbiricik Ferihan Aral Refik Tanakol Ayşe Kubat Üzüm

https://doi.org/10.26650/IUITFD.1252240

Abstract

Amaç: Amiodarona bağlı tirotoksikoz (ABT) hekimler için tanıması ve yönetimi zor, morbidite ve mortalitesi yüksek bir durumdur. Bu çalışmada ABT tanısı, sınıflandırılması ve tedavi için kullanılan parametrelerin retrospektif olarak incelenmesi amaçlanmıştır.
Gereç ve Yöntem: Amiodarona bağlı tirotoksikoz nedeniyle ayaktan tedavi gören hastalar dahil edildi. Demografik özellikler, kalp ve tiroid hastalıklarının varlığı ve özellikleri, amiodaron maruziyetinin zamanı ve dozu, tiroid fonksiyon testleri ve otoantikorları ve tiroid hastalığının tanı yöntemleri ve yönetimi kaydedildi.
Bulgular: Tip 1 (n:12; %48), tip 2 (n:7; %28) ve mikst tip (n:6; %24) ABT olarak sınıflandırılan 25 hasta (ortalama yaş: 64,1±15,3 yıl, %56’sı erkek) çalışmaya dahil edildi. Tip 1 ABT, tip 2 ABT ile karşılaştırıldığında, serbest T3 ve T4 konsantrasyonları sırasıyla 5,1±1,6 pmol/L’ye karşı 7,6±2,4 pmol/L ve 29,2±8,8 pmol/L’ye karşı 34,9±11 pmol/L idi. İkinci saat radyoaktif iyot tutulumu 24. saat radyoaktif iyot tutulumu ile pozitif korelasyon gösterdi (p=0.005). Tedavide sırasıyla, antitiroid ilaç (n:20) 24 ay, glukokortikoid (n:7) 7,4±1,7 ay ve sodyum perklorat (n:5) 3,5±2 ay kullanıldı. Tip 1 ABT için ilk tedavi seçeneği metimazol ve tip 2 ABT için metilprednizolon idi. Tip 2 ABT ‘da remisyon süresi daha kısaydı (p=0,009). Beş hastaya radyoaktif iyot tedavisi, bir hastaya tiroidektomi uygulandı.
Sonuç: Amiodaron ile indüklenen tirotoksikozların yönetimi zordur. Bu hastaların tekrar amiodarona ihtiyaç duyabileceği akılda tutulmalı, bu nedenle ihtiyaç halinde ablatif tedaviler planlanmalıdır.

Keywords

Amiodaron tirotoksikozu metimazol metilprednizolon perklorat

References

  • 1. Reiffel JA, Estes NA 3rd, Waldo AL, Prystowsky EN, DiBianco R. A consensus report on antiarrhythmic drug use. Clin Cardiol 1994;17(3):103-16. [CrossRef] google scholar
  • 2. Holt DW, Tucker GT, Jackson PR, Storey GC. Amiodarone pharmacokinetics. Am Heart J 1983;106(4 Pt 2):840-7. [CrossRef] google scholar
  • 3. Amiodarone and the thyroid: the Janus response. Lancet1987;330(8549):24-5. [CrossRef] google scholar
  • 4. Wiersinga WM. Amiodarone and the thyroid. In: Weetman AP, Grossman A (eds). Pharmacotherapeutics of the thyroid gland. Berlin: SpringerVerlag, 1997;225-87. [CrossRef] google scholar
  • 5. Beddows SA, Page SR, Taylor AH, McNerney R, Whitley GS, Johnstone AP, et al. Cytotoxic effects of amiodarone and desethylamiodarone on human thyrocytes. Biochem Pharmacol 1989;38(24):4397-403. [CrossRef] google scholar
  • 6. Bagchi N, Brown TR, Urdanivia E, Sundick RS. Induction of autoimmune thyroiditis in chickens by dietary iodine. Science 1985;230(4723):325-7. [CrossRef] google scholar
  • 7. Harjai KJ, Licata AA. Effects of amiodarone on thyroid function. Ann Intern Med 1997;126(1):63-73. [CrossRef] google scholar
  • 8. Newnham HH, Topliss DJ, Le Grand BA, Chosich N, Harper RW, Stockigt JR. Amiodarone-induced hyperthyroidism: assessment of the predictive value of biochemical testing and response to combined therapy using propylthiouracil and potassium perchlorate. Aust N Z J Med 1988;18(1):37-44. [CrossRef] google scholar
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  • 10. Bogazzi F, Bartalena L, Brogioni S, Mazzeo S, Vitti P, Burelli A, et al. Color flow Doppler sonography rapidly differentiates type I and type II amiodarone-induced thyrotoxicosis. Thyroid 1997;7(4):541-5. [CrossRef] google scholar
  • 11. Cooper DS. Antithyroid drugs. N Engl J Med 2005;352(9):905-17. [CrossRef] google scholar
  • 12. Martino E, Mariotti S, Aghini-Lombardi F, Lenziardi M, Morabito S, Baschieri L, et al. Short term administration of potassium perchlorate restores euthyroidism in amiodarone iodine-induced hypothyroidism. J Clin Endocrinol Metab 1986;63(5):1233-6. [CrossRef] google scholar
  • 13. Wolff J. Perchlorate and the thyroid gland. Pharmacol Rev 1998;50(1):89-105. google scholar
  • 14. Eaton SE, Euinton HA, Newman CM, Weetman AP, Bennet WM. Clinical experience of amiodarone-induced thyrotoxicosis over a 3-year period: role of colour-flow Doppler sonography. Clin Endocrinol (Oxf) 2002;56(1):33-8. [CrossRef] google scholar
  • 15. Han TS, Williams GR, Vanderpump MP. Benzofuran derivatives and the thyroid. Clin Endocrinol (Oxf) 2009;70(1):2-13. [CrossRef] google scholar
  • 16. Meurisse M, Hamoir E, D’Silva M, Joris J, Hennen G. Amiodarone-induced thyrotoxicosis: is there a place for surgery? World J Surg 1993;17(5):622-6. [CrossRef] google scholar
  • 17. Hamoir E, Meurisse M, Defechereux T, Joris J, Vivario J, Hennen G. Surgical management of amiodarone-associated thyrotoxicosis: too risky or too effective? World J Surg 1998;22(6):537-42. [CrossRef] google scholar
  • 18. Farwell AP, Abend SL, Huang SK, Patwardhan NA, Braverman LE. Thyroidectomy for amiodarone-induced thyrotoxicosis. JAMA 1990;263(11):1526-8. [CrossRef] google scholar
  • 19. Brunn J, Block U, Ruf G, Bos I, Kunze WP, Scriba PC. Volumetrie der Schilddrüsenlappen mittels Real-time-Sonographie [Volumetric analysis of thyroid lobes by real-time ultrasound (author’s transl)]. Dtsch Med Wochenschr 1981;106(41):1338-40. [CrossRef] google scholar
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  • 22. Macchia PE, Feingold KR. Amiodarone Induced Thyrotoxicosis. In: Feingold KR, Anawalt B, Blackman MR, et al, editors. Endotext (serial online). South Dartmouth (MA);2000 (cited 2023 February 26). Available from: URL: https://www.ncbi.nlm.nih.gov/books/NBK279030/. google scholar
  • 23. Ross IL, Marshall D, Okreglicki A, Isaacs S, Levitt NS. Amiodarone-induced thyroid dysfunction. S Afr Med J 2005;95(3):180-3. [CrossRef] google scholar
  • 24. Albert SG, Alves LE, Rose EP. Thyroid dysfunction during chronic amiodarone therapy. J Am Coll Cardiol 1987;9(1):175-83. [CrossRef] google scholar
  • 25. Raghavan RP, Taylor PN, Bhake R, Vaidya B, Martino E, Bartalena L, et al. Amiodarone-induced thyrotoxicosis, an overview of UK management. Clin Endocrinol (Oxf) 2012;77(6):936-7. [CrossRef] google scholar
  • 26. Tanda ML, Piantanida E, Lai A, Liparulo L, Sassi L, Bogazzi F, et al. Diagnosis and management of amiodarone-induced thyrotoxicosis: similarities and differences between North American and European thyroidologists. Clin Endocrinol (Oxf) 2008;69(5):812-8. [CrossRef] google scholar
  • 27. Erdogan MF, Güleç S, Tutar E, Başkal N, Erdogan G. A stepwise approach to the treatment of amiodarone-induced thyrotoxicosis. Thyroid 2003;13(2):205-9. [CrossRef] google scholar
  • 28. Bartalena L, Bogazzi F, Chiovato L, Hubalewska-Dydejczyk A, Links TP, Vanderpump M. 2018 European Thyroid Association (ETA) Guidelines for the Management of Amiodarone-Associated Thyroid Dysfunction. Eur Thyroid J 2018;7(2):55-66. [CrossRef] google scholar
  • 29. Maqdasy S, Batisse-Lignier M, Auclair C, Desbiez F, Citron B, Thieblot P, et al. Amiodarone-ınduced thyrotoxicosis recurrence after amiodarone reintroduction. Am J Cardiol 2016;117(7):1112-6. [CrossRef] google scholar
  • 30. Czarnywojtek A, Plazinska MT, Zgorzalewicz-Stachowiak M, Wolinski K, Stangierski A, Miechowicz I, et al. Dysfunction of the thyroid gland during amiodarone therapy: a study of 297 cases. Ther Clin Risk Manag 2016;12:505-13. [CrossRef] google scholar
  • 31. Trip MD, Wiersinga W, Plomp TA. Incidence, predictability, and pathogenesis of amiodarone-induced thyrotoxicosis and hypothyroidism. Am J Med 1991;91(5):507-11. [CrossRef] google scholar
  • 32. Gursoy A, Tutuncu NB, Gencoglu A, Anil C, Demirer AN, Demirag NG. Radioactive iodine in the treatment of type-2 amiodarone-induced thyrotoxicosis. J Natl Med Assoc 2008;100(6):716-9. [CrossRef] google scholar

RETROSPECTIVE EVALUATION OF DIAGNOSTIC METHODS AND TREATMENT OPTIONS IN AMIODARONE-INDUCED THYROTOXICOSIS

Year 2023, Volume: 86 Issue: 3, 227 - 234, 26.10.2023

Nezahat Müge Çatıkkaş Hülya Hacişahinoğulları Nurdan Gül Özlem Soyluk Selçukbiricik Ferihan Aral Refik Tanakol Ayşe Kubat Üzüm

https://doi.org/10.26650/IUITFD.1252240

Abstract

Objective: Amiodarone-induced thyrotoxicosis is an important cause of morbidity and mortality that is difficult for physicians to recognize and manage. We retrospectively analyzed the parameters used for diagnosis, classification, and treatment for amiodarone-induced thyrotoxicosis.
Material and Method: We included patients who had amiodarone-induced thyrotoxicosis (AIT). We recorded the demographics, the presence and characteristics of heart and thyroid diseases, the time and dosage of amiodarone exposure, thyroid function tests and thyroid auto-antibodies, and the diagnostic methods and management of thyroid disease.
Result: We included 25 patients (mean age: 64.1±15.3 years, 56% male) who were classified as type 1 (n:12; 48%), type 2 (n:7; 28%), and mixed-type amiodarone-induced thyrotoxicosis (AIT) (n:6; 24%). In the comparison of type 1 AIT to 2 AIT, free T3 and T4 concentrations were 5.1±1.6 pmol/L vs. 7.6±2.4 pmol/L, and 29.2±8.8 pmol/L vs. 34.9±11pmol/L, respectively. Iodine uptake measurement at the 2nd hours were positively correlated with the 24th-hour measurement (p=0.005). Antithyroid drug (n:20) was given for 24 months, glucocorticoid (n:7) and sodium perchlorate (n:5) were given for 7.4±1.7 and 3.5±2 months, respectively. The first treatment option was methimazole for type 1 AIT and methylprednisolone for type 2 AIT. The duration of remission was shorter in type 2 AIT (p=0.009). Five patients had radioactive iodine treatment, and one underwent thyroidectomy.
Conclusion: The management of AITs is difficult. It should be kept in mind that these patients may need amiodarone again; therefore, ablative treatments should be planned if needed.

Keywords

Amiodarone induced thyrotoxicosis methimazole methylprednisolone perchlorate

References

  • 1. Reiffel JA, Estes NA 3rd, Waldo AL, Prystowsky EN, DiBianco R. A consensus report on antiarrhythmic drug use. Clin Cardiol 1994;17(3):103-16. [CrossRef] google scholar
  • 2. Holt DW, Tucker GT, Jackson PR, Storey GC. Amiodarone pharmacokinetics. Am Heart J 1983;106(4 Pt 2):840-7. [CrossRef] google scholar
  • 3. Amiodarone and the thyroid: the Janus response. Lancet1987;330(8549):24-5. [CrossRef] google scholar
  • 4. Wiersinga WM. Amiodarone and the thyroid. In: Weetman AP, Grossman A (eds). Pharmacotherapeutics of the thyroid gland. Berlin: SpringerVerlag, 1997;225-87. [CrossRef] google scholar
  • 5. Beddows SA, Page SR, Taylor AH, McNerney R, Whitley GS, Johnstone AP, et al. Cytotoxic effects of amiodarone and desethylamiodarone on human thyrocytes. Biochem Pharmacol 1989;38(24):4397-403. [CrossRef] google scholar
  • 6. Bagchi N, Brown TR, Urdanivia E, Sundick RS. Induction of autoimmune thyroiditis in chickens by dietary iodine. Science 1985;230(4723):325-7. [CrossRef] google scholar
  • 7. Harjai KJ, Licata AA. Effects of amiodarone on thyroid function. Ann Intern Med 1997;126(1):63-73. [CrossRef] google scholar
  • 8. Newnham HH, Topliss DJ, Le Grand BA, Chosich N, Harper RW, Stockigt JR. Amiodarone-induced hyperthyroidism: assessment of the predictive value of biochemical testing and response to combined therapy using propylthiouracil and potassium perchlorate. Aust N Z J Med 1988;18(1):37-44. [CrossRef] google scholar
  • 9. Martino E, Bartalena L, Mariotti S, Aghini-Lombardi F, Ceccarelli C, Lippi F, et al. Radioactive iodine thyroid uptake in patients with amiodarone-iodine-induced thyroid dysfunction. Acta Endocrinol (Copenh) 1988;119(2):167-73 [CrossRef] google scholar
  • 10. Bogazzi F, Bartalena L, Brogioni S, Mazzeo S, Vitti P, Burelli A, et al. Color flow Doppler sonography rapidly differentiates type I and type II amiodarone-induced thyrotoxicosis. Thyroid 1997;7(4):541-5. [CrossRef] google scholar
  • 11. Cooper DS. Antithyroid drugs. N Engl J Med 2005;352(9):905-17. [CrossRef] google scholar
  • 12. Martino E, Mariotti S, Aghini-Lombardi F, Lenziardi M, Morabito S, Baschieri L, et al. Short term administration of potassium perchlorate restores euthyroidism in amiodarone iodine-induced hypothyroidism. J Clin Endocrinol Metab 1986;63(5):1233-6. [CrossRef] google scholar
  • 13. Wolff J. Perchlorate and the thyroid gland. Pharmacol Rev 1998;50(1):89-105. google scholar
  • 14. Eaton SE, Euinton HA, Newman CM, Weetman AP, Bennet WM. Clinical experience of amiodarone-induced thyrotoxicosis over a 3-year period: role of colour-flow Doppler sonography. Clin Endocrinol (Oxf) 2002;56(1):33-8. [CrossRef] google scholar
  • 15. Han TS, Williams GR, Vanderpump MP. Benzofuran derivatives and the thyroid. Clin Endocrinol (Oxf) 2009;70(1):2-13. [CrossRef] google scholar
  • 16. Meurisse M, Hamoir E, D’Silva M, Joris J, Hennen G. Amiodarone-induced thyrotoxicosis: is there a place for surgery? World J Surg 1993;17(5):622-6. [CrossRef] google scholar
  • 17. Hamoir E, Meurisse M, Defechereux T, Joris J, Vivario J, Hennen G. Surgical management of amiodarone-associated thyrotoxicosis: too risky or too effective? World J Surg 1998;22(6):537-42. [CrossRef] google scholar
  • 18. Farwell AP, Abend SL, Huang SK, Patwardhan NA, Braverman LE. Thyroidectomy for amiodarone-induced thyrotoxicosis. JAMA 1990;263(11):1526-8. [CrossRef] google scholar
  • 19. Brunn J, Block U, Ruf G, Bos I, Kunze WP, Scriba PC. Volumetrie der Schilddrüsenlappen mittels Real-time-Sonographie [Volumetric analysis of thyroid lobes by real-time ultrasound (author’s transl)]. Dtsch Med Wochenschr 1981;106(41):1338-40. [CrossRef] google scholar
  • 20. Von Elm E, Altman DG, Egger M, Pocock SJ, G0tzsche PC, Vandenbroucke JP. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: Guidelines for reporting observational studies. Ann Intern Med 2007;147(8):573-7. [CrossRef] google scholar
  • 21. Altman DG, Gore SM, Gardner MJ, Pocock SJ. Statistical guidelines for contributors to medical journals. Br Med J 1983;286(6376):1489-93. [CrossRef] google scholar
  • 22. Macchia PE, Feingold KR. Amiodarone Induced Thyrotoxicosis. In: Feingold KR, Anawalt B, Blackman MR, et al, editors. Endotext (serial online). South Dartmouth (MA);2000 (cited 2023 February 26). Available from: URL: https://www.ncbi.nlm.nih.gov/books/NBK279030/. google scholar
  • 23. Ross IL, Marshall D, Okreglicki A, Isaacs S, Levitt NS. Amiodarone-induced thyroid dysfunction. S Afr Med J 2005;95(3):180-3. [CrossRef] google scholar
  • 24. Albert SG, Alves LE, Rose EP. Thyroid dysfunction during chronic amiodarone therapy. J Am Coll Cardiol 1987;9(1):175-83. [CrossRef] google scholar
  • 25. Raghavan RP, Taylor PN, Bhake R, Vaidya B, Martino E, Bartalena L, et al. Amiodarone-induced thyrotoxicosis, an overview of UK management. Clin Endocrinol (Oxf) 2012;77(6):936-7. [CrossRef] google scholar
  • 26. Tanda ML, Piantanida E, Lai A, Liparulo L, Sassi L, Bogazzi F, et al. Diagnosis and management of amiodarone-induced thyrotoxicosis: similarities and differences between North American and European thyroidologists. Clin Endocrinol (Oxf) 2008;69(5):812-8. [CrossRef] google scholar
  • 27. Erdogan MF, Güleç S, Tutar E, Başkal N, Erdogan G. A stepwise approach to the treatment of amiodarone-induced thyrotoxicosis. Thyroid 2003;13(2):205-9. [CrossRef] google scholar
  • 28. Bartalena L, Bogazzi F, Chiovato L, Hubalewska-Dydejczyk A, Links TP, Vanderpump M. 2018 European Thyroid Association (ETA) Guidelines for the Management of Amiodarone-Associated Thyroid Dysfunction. Eur Thyroid J 2018;7(2):55-66. [CrossRef] google scholar
  • 29. Maqdasy S, Batisse-Lignier M, Auclair C, Desbiez F, Citron B, Thieblot P, et al. Amiodarone-ınduced thyrotoxicosis recurrence after amiodarone reintroduction. Am J Cardiol 2016;117(7):1112-6. [CrossRef] google scholar
  • 30. Czarnywojtek A, Plazinska MT, Zgorzalewicz-Stachowiak M, Wolinski K, Stangierski A, Miechowicz I, et al. Dysfunction of the thyroid gland during amiodarone therapy: a study of 297 cases. Ther Clin Risk Manag 2016;12:505-13. [CrossRef] google scholar
  • 31. Trip MD, Wiersinga W, Plomp TA. Incidence, predictability, and pathogenesis of amiodarone-induced thyrotoxicosis and hypothyroidism. Am J Med 1991;91(5):507-11. [CrossRef] google scholar
  • 32. Gursoy A, Tutuncu NB, Gencoglu A, Anil C, Demirer AN, Demirag NG. Radioactive iodine in the treatment of type-2 amiodarone-induced thyrotoxicosis. J Natl Med Assoc 2008;100(6):716-9. [CrossRef] google scholar
There are 32 citations in total.

Details

Primary Language English
Subjects Health Services and Systems (Other)
Journal Section RESEARCH
Authors

Nezahat Müge Çatıkkaş 0000-0003-2494-1625

Hülya Hacişahinoğulları 0000-0001-9989-6473

Nurdan Gül 0000-0002-1187-944X

Özlem Soyluk Selçukbiricik 0000-0003-0732-4764

Ferihan Aral 0000-0003-3838-1219

Refik Tanakol 0000-0003-1636-1444

Ayşe Kubat Üzüm 0000-0003-0478-1193

Publication Date October 26, 2023
Submission Date February 19, 2023
Published in Issue Year 2023 Volume: 86 Issue: 3

Cite

APA Çatıkkaş, N. M., Hacişahinoğulları, H., Gül, N., Soyluk Selçukbiricik, Ö., et al. (2023). RETROSPECTIVE EVALUATION OF DIAGNOSTIC METHODS AND TREATMENT OPTIONS IN AMIODARONE-INDUCED THYROTOXICOSIS. Journal of Istanbul Faculty of Medicine, 86(3), 227-234. https://doi.org/10.26650/IUITFD.1252240
AMA Çatıkkaş NM, Hacişahinoğulları H, Gül N, Soyluk Selçukbiricik Ö, Aral F, Tanakol R, Kubat Üzüm A. RETROSPECTIVE EVALUATION OF DIAGNOSTIC METHODS AND TREATMENT OPTIONS IN AMIODARONE-INDUCED THYROTOXICOSIS. İst Tıp Fak Derg. October 2023;86(3):227-234. doi:10.26650/IUITFD.1252240
Chicago Çatıkkaş, Nezahat Müge, Hülya Hacişahinoğulları, Nurdan Gül, Özlem Soyluk Selçukbiricik, Ferihan Aral, Refik Tanakol, and Ayşe Kubat Üzüm. “RETROSPECTIVE EVALUATION OF DIAGNOSTIC METHODS AND TREATMENT OPTIONS IN AMIODARONE-INDUCED THYROTOXICOSIS”. Journal of Istanbul Faculty of Medicine 86, no. 3 (October 2023): 227-34. https://doi.org/10.26650/IUITFD.1252240.
EndNote Çatıkkaş NM, Hacişahinoğulları H, Gül N, Soyluk Selçukbiricik Ö, Aral F, Tanakol R, Kubat Üzüm A (October 1, 2023) RETROSPECTIVE EVALUATION OF DIAGNOSTIC METHODS AND TREATMENT OPTIONS IN AMIODARONE-INDUCED THYROTOXICOSIS. Journal of Istanbul Faculty of Medicine 86 3 227–234.
IEEE N. M. Çatıkkaş, “RETROSPECTIVE EVALUATION OF DIAGNOSTIC METHODS AND TREATMENT OPTIONS IN AMIODARONE-INDUCED THYROTOXICOSIS”, İst Tıp Fak Derg, vol. 86, no. 3, pp. 227–234, 2023, doi: 10.26650/IUITFD.1252240.
ISNAD Çatıkkaş, Nezahat Müge et al. “RETROSPECTIVE EVALUATION OF DIAGNOSTIC METHODS AND TREATMENT OPTIONS IN AMIODARONE-INDUCED THYROTOXICOSIS”. Journal of Istanbul Faculty of Medicine 86/3 (October 2023), 227-234. https://doi.org/10.26650/IUITFD.1252240.
JAMA Çatıkkaş NM, Hacişahinoğulları H, Gül N, Soyluk Selçukbiricik Ö, Aral F, Tanakol R, Kubat Üzüm A. RETROSPECTIVE EVALUATION OF DIAGNOSTIC METHODS AND TREATMENT OPTIONS IN AMIODARONE-INDUCED THYROTOXICOSIS. İst Tıp Fak Derg. 2023;86:227–234.
MLA Çatıkkaş, Nezahat Müge et al. “RETROSPECTIVE EVALUATION OF DIAGNOSTIC METHODS AND TREATMENT OPTIONS IN AMIODARONE-INDUCED THYROTOXICOSIS”. Journal of Istanbul Faculty of Medicine, vol. 86, no. 3, 2023, pp. 227-34, doi:10.26650/IUITFD.1252240.
Vancouver Çatıkkaş NM, Hacişahinoğulları H, Gül N, Soyluk Selçukbiricik Ö, Aral F, Tanakol R, Kubat Üzüm A. RETROSPECTIVE EVALUATION OF DIAGNOSTIC METHODS AND TREATMENT OPTIONS IN AMIODARONE-INDUCED THYROTOXICOSIS. İst Tıp Fak Derg. 2023;86(3):227-34.
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