Endocrine Abstracts

Case history: 62 Year old male known to have inflammatory bowel disease, ischemic cardiomyopathy, ICD implant for sustained ventricular tachycardia was referred to endocrine clinic by the GP for thyrotoxicosis which was found on lab workup for worsening diarrhoea and tiredness.

Drug history

Amiodarone 200 mg od since 2012, Bisoprolol, Eplerenone, Atorvastain and Pentasa.

Investigations: FT4 48.6 pmol/l (6.5–17.0) TSH0.03 (0.35–4.94) TPO antibodies negative. USG thyroid showed a normal gland with normal vascular flow.

Results and treatment: Diagnosed as amiodarone induced thyrotoxicosis (AIT) and initially was commenced on carbimazole 40 mg and prednisolone 40 mg was added after 4 weeks as there were no improvement in his thyroid function test results. His carbimazole was stopped by his GP 2 weeks after as the patient developed severe rash. As TFTs improved by then we continued him on tapering dose of prednisolone.He was advised to continue amiodarone by the cardiologist in view of his VT and cardiomyopathy. His colitis flared up when prednisolone dose was tapered down to 10 mg, Hence GP increased prednisolone to 20 mg though his FT4 14.2 and TSH 1.9 were in normal ranges then. He was commenced on azathioprine by the gastroenterologist and his prednisolone gradually withdrawn as the patient developed steroid induced diabetes. He is asymptomatic with latest FT413.5 and TSH12.6

Conclusions and points for discussion:

i) Diagnostic and therapeutic challenges in AIT

ii) Amiodarone-whether to stop or not?