Amiodarone
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Drug-induced thyrotoxicosis: case report A 54-year-old man developed drug-induced thyrotoxicosis during treatment with amiodarone for ventricular arrhythmia. The man, who had a history of myocardial infarction and coronary artery disease, presented to the emergency department with sustained monomorphic ventricular tachycardia, which resulted in frequent shock from his implantable cardioverter-defibrillator. His condition worsened rapidly. He was subsequently intubated with extracorporeal membrane oxygenation, after admission to the ICU. He had been receiving amiodarone [route not stated] for 2 years for ventricular arrhythmia and the dose was increased recently before the current presentation to from 200 mg/day to 150mg twice daily. His cardiac rhythm returned to normal sinus rhythm; however, due to frequent episodes of ventricular fibrillation, which compromised haemodynamic stability, he was re-admitted to the ICU. Two weeks after admission, thyroid function tests revealed an elevated free T4 (FT4) and a low TSH. He was diagnosed with type 2 amiodarone-induced thyrotoxicosis, as he presented with onset of thyrotoxicosis at almost 2 years after the commencement of amiodarone therapy without any previous history of a thyroid disorder. The man was started on treatment with prednisone. However, he still had hyperthyroidism 7 days after prednisone initiation. In view of insufficient response from prednisone, thiamazole was added to the ongoing prednisone therapy. Given baseline characteristics, the possibility of type 2 AIT with a delayed response to glucocorticoids could not be excluded. However, due to his critical cardiac condition, he required prompt normalisation of thyroid function. Therefore, treatment with both thiamazole and prednisone was started. His thyroid function improved after 10 days of treatment with prednisone and thiamazole. Therapy with thiamazole and prednisone was continued without a change in dose. His thyroid function tests were observed within the normal range after one week. He was continued on the same therapy for 7 more days and his thyroid function tests showed further improvement. The treatment with amiodarone was continued because it was essential for his cardiac condition. Ylli D, et al. Evaluation and Treatment of Amiodarone-Induced Thyroid Disorders. Journal of Clinical Endocrinology and Metabolism : no pagination, 7 Nov 2020. Available 803519816 from: URL: http://doi.org/10.1210/clinem/dgaa686
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Reactions 12 Dec 2020 No. 1834
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