ECE2017 Eposter Presentations: Thyroid Clinical case reports - Thyroid/Others (30 abstracts)
Amiodarone and refractory thyrotoxicosis in a patient with complex arrhythmia
Nelson Cunha 1 , Leonor Gomes 1, , Diana Martins 1, , Diana Oliveira 1, , Adriana Lages 1 , Mara Ventura 1 , Lúcia Fadiga 1 , Diana Catarino 1 & Francisco Carrilho 1
1Endocrinology, Diabetes and Metabolism Department, University Hospital of Coimbra, Coimbra, Portugal; 2Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
Background: Amiodarone is a potent antiarrhythmic drug used to treat tachyarrhythmias. However, is linked to a number of adverse effects, including thyroid dysfunction. It is the main cause of drug-induced thyrotoxicosis. Here we report a clinical case of amiodarone-induced thyrotoxicosis (AIT) in a patient with complex ventricular dysrhythmia.
Case report: A 23 years-old women with dilated cardiomyopathy, severe depression of ejection fraction of left ventricle and complex ventricular dysrhythmia under amiodarone treatment 200 mg id since June of 2013, presented asthenia and weight loss since march of 2016, with worsening of heart failure. TSH was <0.008 μUI/ml (0.4-4.0), Free T4 (FT4) 3.4 ng/dl (0.8–1.9) and Free T3 (FT3) 6.1 pg/ml (1.8–4.2). Autoimmunity was negative. Thyroid ultrasound: normal dimensions, without nodularity or increased vascularity at doppler study. 99mTc-sestamibi thyroid scintigraphy: signal in lower limit of normality. It was started methimazole 30 mg/day and prednisolone 40 mg/day. After 3 months, she presented undetectable TSH, FT4 2.4 ng/dl and FT3 4.0 pg/ml. Methimazole was increased to 40 mg/day and prednisolone to 60mg/day and amiodarone was suspended. After 2 months, TSH was still undetectable and FT4 2.2 ng/dl, with development of steroids side effects. So thyroidectomy was performed, without complications. After surgery, started levothyroxine 75 μg/day, steroids were tapered and amiodarone was restarted. Three months after surgery, normal thyroid function and improvement of her clinical condition were observed.
Conclusion: In this case, a type 2 AIT was diagnosed, resistant to medical therapy and with steroids side effects. This uncommon scenario illustrates the difficulty of controlling thyrotoxicosis in a patient of high risk of sudden death, requiring an invasive procedure to its resolution. Thereby, when thyrotoxicosis is uncontrollable and patients are at high cardiovascular risk, thyroidectomy should be considered for the resolution of AIT. This could be lifesaving by controlling the disease, avoiding iatrogeny and maintaining the possibility of amiodarone therapy.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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