Amiodarone
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Myxoedema coma: case report A 74-year-old woman developed myxoedema coma during treatment with amiodarone for atrial fibrillation. The woman presented with a two-week history of lethargy, worsening generalised weakness, constipation, lower extremity swelling and cold intolerance. Her medical history was significant for atrial fibrillation, hypertension and hypothyroidism. She had been receiving treatment with amiodarone [route and dosage not stated] along with chlortalidone and levothyroxine sodium [levothyroxine]. On previous admission 2 months previously for dehydration, her TSH level was 0.1586 µIU/mL and free T4 was 1.48 ng/dL. At that time, the dose of levothyroxine sodium was decreased from 175µg to 112µg daily. At current hospitalisation, her heart rate was 39 beats/minute and BP was 89/42mm Hg. She was found to be drowsy with reduced responsiveness and was able to answer the questions. Laboratory findings were as follows; sodium level was 110 mmol/L (hyponatraemia), TSH was 87.67 µIU/mL and free T4 was 0.99 ng/dL. After 2 days, the level of free T3 was less than 1 pg/mL [time to reaction onset not stated]. The woman’s treatment with amiodarone was stopped and was treated with hydrocortisone, levothyroxine sodium and sodium chloride [hypertonic saline]. Subsequently, liothyronine was added to her therapy. Eventually, improvement in her haemodynamic parameters, laboratory values and overall clinical condition was noted. Author comment: "We describe a case of severe hypothyroidism in the setting of amiodarone use, manifesting as myxedema coma, a significantly elevated thyroidstimulating hormone (TSH), normal free thyroxine (T4), undetectable free triiodothyronine (T3) and contributing to a life-threatening hyponatremia, cardiorespiratory compromise, and neurologic abnormalities." Tarar OH, et al. Myxedema coma in a patient with hypothyroidism and amiodarone use. Thyroid 29 (Suppl. 1): A-74 (plus poster) abstr. 206, 29 Oct 2019. Available from: URL: http://doi.org/10.1089/thy.2019.29085.abstracts [abstract] 803437215 USA
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Reactions 30 Nov 2019 No. 1781
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