ECE2022 Eposter Presentations Thyroid (219 abstracts)
Role of plasmapheresis in the management of severe amiodarone-induced hyperthyroidism refractory to conventional medical treatment
Belén García Izquierdo 1 , Macarena Contreras Angulo 2 , Laura Armengod Grao 2 , Carlos García Gómez 2 , Álvaro García García 3 , Azucena Losa Maroto 3 , José Luis Bueno Cabrera 3 , Miguel Juan García- Oria Serrano 4 , Encarnació n Donoso 5 & Pedro Iglesias 2
1Hospital Universitario Puerta de Hierro Majadahonda, Endocrinology and Nutrition, Majadahonda, Spain; 2Hospital Universitario Puerta de Hierro Majadahonda, Endocrinology and Nutrition, Madrid, Spain; 3Hospital Universitario Puerta de Hierro Majadahonda, Hematology, Madrid, Spain; 4Hospital Universitario Puerta de Hierro Majadahonda, General and Digestive Surgery, Madrid, Spain; 5Hospital Universitario Puerta de Hierro Majadahonda, Biochemistry, Madrid, Spain
Introduction: Amiodarone is an antiarrhythmic drug whose high iodine content may influence thyroid function. The first line treatment of amiodarone-induced hyperthyroidism (AIH) is mainly medical. Plasmapheresis has been used in cases of antithyroid intolerance or refractory hyperthyroidism, although clinical experience is poor.
Clinical case: We present a case of a patient with structural heart disease and severe AIH refractory to medical treatment who required a high number of plasmapheresis cycles to achieve adequate control of thyroid function before definitive treatment. A 53-year-old man, with atrial fibrillation treated with amiodarone (200 mg/day) for 3 years until 2 months prior to admission, was hospitalized due to chest pain. Echocardiography showed an atrial septal defect, with indication for non-urgent surgical closure. During admission, severe hyperthyroidism was discovered (TSH <0.01 µIU/ml, normal range (NR): 0.35-5.0; free T4 (FT4) 10.03 ng/dl, NR: 0.7-1.98; and free T3 (FT3) 9.3 pg/ml, NR: 2.3-4.2). A grade 2 diffuse goiter was palpable. Thyroid autoimmunity study was negative. Suspecting AIH, medical treatment with antithyroid drugs and corticosteroids was started. The difficulty in controlling thyroid function led to an increase in treatment up to 45 mg/day of methimazole, prednisone (90 mg/day), cholestyramine (16 g/day) and of potassium perchlorate (800 mg/day). After 3 weeks, hyperthyroidism persisted (TSH < 0.01 µIU/ml, FT4 11.92 ng/dl and FT3 9.76 pg/ml), establishing the diagnosis of severe AIH refractory to medical treatment; therefore, total thyroidectomy was considered. In order to reduce the perioperative cardiovascular risk, treatment with plasmapheresis was started. As complications, he presented several episodes of skin rash, a slight tendency to anemization (hemoglobin nadir 11.2 g/dl, NR: 12.0-17.0) and asymptomatic hypocalcemia with a minimum value of 7.6 mg/dl (NR: 8.7-10.3 mg/dl). After 17 sessions of plasmapheresis, a reduction in circulating levels of thyroid hormones was achieved (TSH 0.01 µIU/ml, FT4 4.33 ng/dl and FT3 4.95 pg/ml), which allowed definitive treatment with surgery 40 days after diagnosis.
Conclusion: Plasmapheresis in association with medical treatment is a useful tool in the management of severe AIH refractory to conventional therapy with maximal doses in preparation for definitive treatment with thyroid surgery.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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