Endocrine Abstracts

Introduction: Type 2 amiodarone-induced thyrotoxicosis (AIT2), resulting from the release of thyroid hormones, is a rarer form of side effect of this drug. Treatment of thyrotoxicosis in patients with end stage renal disease (ESRD) is difficult because hemodialysis alters renal clearance of drugs and iodine, may impact the results of assessment and treatment and can increase the medical instability of patients.

Aim: The aim was to present the difficulties of AIT2 treatment in a patient with ERDS.

Case report: Forty seven-year-old man treated with hemodialysis four times a week for 3.5 years. Because of recurrent episodes of atrial flutter and fibrillation amiodarone was applied by 1.5 months. Due to arrhythmias recurrence, evaluation of thyroid function was performed and thyrotoxicosis was recognized. Amiodarone was withdrawn and thiamazole and prednisone have been applied. After slight improvement, the concentrations of thyroid hormones significantly raised with TRAb-0.4 U/l (n<1.5), a/TPO-86U/l (n<60), a/TG-89U/l (n<60). In ultrasound thyroid goiter [47 ml] with heterogeneous structure and reduced vascularization was detected. The lack of 99 mTc uptake in scintigraphy was found. The patient received thiamazole, prednisolone and lithium carbonicum again together with sodium perchlorate. After another short-term of an improvement, deterioration of the disease appeared (FT₄−60.8 pmol/l (n<22), FT₃−39.2 pmol/l (n<7), TSH<0.04 mIU/l). The results of imaging studies justified AIT2 recognition. Antithyroid drugs and sodium perchlorate were withdrawn. High dose of prednisolone was continued. In order to accelerate the elimination of the free thyroid hormones three cycles of plasmapheresis were conducted. Normalization of hormones was reached after five months of onset of the disease.

Conclusions: Similarly as in the case of patients without renal failure, only prednisone is effective in treatment of AIT2 in ESRD. Hemodialysis is ineffective and plasmapheresis is slightly effective in the elimination of free thyroid hormones. Monitoring of thyrotoxicosis and assessment of the effects of treatment in patients with ESRD are difficult.