Endocrine Abstracts

50yrs old male with AF diagnosed in 2018. Had a failed ablation. Started on amiodarone from June 2021 to July 202 that was stopped and started on diltiazem for rate control. No history of previous thyroid disease or family history of thyroid no goiter. GP picked up thyrotoxicosis in August 2022 in bloods, started him on carbimazole and referred to endocrine. In terms of thyroid there was weight loss, tremulousness and sob. TRAB was negative. Prednisolone started given history of amiodarone intake for a long time and probable diagnosis of amiodarone induced thyrotoxicosis was made and patient was started on prednisolone 40 mg on the top of carbiamzole 40 mg. He responded well to steroids that supported type 2 AID. Uss doppler was inconclusive. TFTs continue to improve after steroids so the carbimazole was weaned slowly to 30 and 20 mg. However, the TFTs began to deteriorate with carbimazole of 20 mg. As a result, the plan for thyroidectomy after discussing with patient was made with sodium perchlorate before surgery to control thyrotoxicosis. Unfortunately, TFTs didn’t improve much on sodium perchlorate hence plasmapheresis was considered as the next option to control tfts. After two sessions of plasmapheresis his tsh and fT4 for the first time normalized. A total thyroidectomy was performed. Steroids weaned down slowly. SST was performed before completely stopping the steroids to ensure no adrenal insufficiency. And now pt is on levothyroxine and symptomatically much better. Started on bone protection given on high dose steroids for a long period of time. Plan for Dexa scan.