Endocrine Abstracts

2 cases of Amiodarone induced thyroiditis. 1. 60 years old gentleman on haemodialysis, secondary to diabetes related kidney failure, on Insulin for diabetes, also on treatment for active pulmonary tuberculosis and on amiodarone for non-sustained VTs for one year and had left ventricular systolic dysfunction. He went into atrial fibrillation during a dialysis session and his thyroid function tests were done along with other blood tests. He was discussed with cardiology who advised to stop amiodarone and switch to bisoprolol. His TFTs were.

• TSH 0.16 mU/I (0.27-4.2)

• T4 37.6 pmol/l (12-22)

• T3 2.8 pmol/l (3.1-6.8)

At this point he was referred to endocrine team. Clinically there was no thyroid swelling or peripheral signs of hyperthyroidism. The patient was started on carbimazole and tapering dose of prednisolone as the type of AIT was not known, thyroid antibodies, thyroid ultrasound scan and Tc thyroid uptake scan was requested. The Thyroid antibodies came back negative, carbimazole dose was reduced and tapering dose of steroids was continued. Thyroid ultrasound came back as normal, Tc Thyroid scan showed homogeneous uptake, and the latest TFTs were normal. 2. 70 years old lady admitted with a fall. Background history of pulmonary embolism, atrial fibrillation, previous multiple cardioversions, anxiety and depression, hypertension and osteoarthritis. Medications included rivaroxaban and amiodarone for 5 years. She was referred to the endocrine team for abnormal thyroid function tests. T4 >100 pmol/land TSH <0.02 mU/l. On examination, she had a normal thyroid and no signs of hyperthyroidism. Cardiology advised to switch amiodarone to bisoprolol. She was started on 40 mg of carbimazole and a tapering dose of steroids. Thyroid antibodies, thyroid ultrasound, and Tc thyroid uptake scan were requested. Thyroid stimulating Immunoglobulins were 0.95 iu/l(<0.56), ultrasound neck showed: mildly enlarged multinodular goiter, background chronic thyroiditis, several benign U2 nodules. Thyroid uptake scan showed, no uptake in the neck, however, this was done after being on carbimazole. The serial thyroid functions showed improvement.