Endocrine Abstracts

Introduction: Amiodarone-induced thyrotoxicosis (AIT) is a well-known complication of amiodarone therapy. Type 1 AIT is caused by excessive iodine-induced thyroid hormone synthesis in abnormal thyroid glands and treated with thionamides; type 2 AIT is a drug induced destructive thyroiditis that responds to glucocorticoids. Mixed forms of AIT need a combined treatment of thionamides and glucocorticoids. In refractory cases of AIT plasmapheresis before total thyroidectomy is an efficacious treatment.

Case report: A 56-year-old woman was admitted to the emergency department with thyrotoxic symptoms of poorly controlled AIT that was diagnosed 3 months ago. Medical history revealed a coronary and valvular heart disease. Laboratory findings were TSH 0.04 mU/l (normal range 0.27–4.20), fT4 52.3 pmol/l (12–22), and fT3 5.6 pmol/l (3.1–6.8). Ultrasound of the thyroid gland showed two nodules and hypovascularisation of the parenchyma, therefore mixed AIT was diagnosed. Lithium and potassium perchlorate were added to the treatment with high dose prednisolone and carbimazole, and amiodarone was discontinued. However, within a week’s time thyrotoxicosis aggravated to fT4 over 100 pmol/l and fT3 to 7.0 pmol/l. Because of the severe thyrotoxicosis refractory to medical therapy, we decided for plasmapheresis and total thyroidectomy. After the second plasmapheresis sudden pain in the left upper abdomen and hypotension occurred. A CT scan of the abdomen disclosed a splenic rupture and splenectomy was performed after another plasmapheresis, followed by total thyroidectomy.

Conclusions: Spontaneous splenic rupture is an extremely rare complication in plasmapheresis. To date and to our knowledge this is the first case of spontaneous splenic rupture occurring during plasmapheresis in a patient with AIT. In addition to anticoagulation during plasmapheresis hyperdynamic state caused by thyrotoxicosis may have contributed to splenic rupture.

Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.

Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector