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Endocrine Abstracts (2014) 35 P1046 | DOI: 10.1530/endoabs.35.P1046

1Endocrinology Departmant, Ankara Numune Education and Research Hospital, Ankara, Turkey; 2Endocrinology Departmant, Medical Faculty, Hitit University, Corum, Turkey.

Introduction: There are two clinical types of amiodarone induced thyrotoxicosis (AIT). Type I AIT appears with hyperthyroidism and type II with a destructive thyrotoxicosis. Treatment of type I AIT includes antithyroid drugs meanwhile type II needs steroids as the first line therapy. If there is no respond to medical treatment, surgical approach must be considered. Here in we present a type II AIT case who had no respond to combined therapy therefore treated with surgical approach.

Case report: A 24-year-old female who had history of recurrent ventricular fibrillation, cardiomyopathy, and using 200 mg/day amiodarone per oral since 2 years. She was referred to our clinic as the thyroid function tests revealed thyrotoxicosis. She had no history of any thyroid disease. On physical examination thyroid gland was non palpable and there were no signs of thyroid ophthalmopathy. Thyroglobulin level was 317.4 ng/dl (1.4–78) and thyroid antibodies were negative. Doppler ultrasonography demonstrated a reduced vascularization in thyroid gland. Tc-99m sestaMIBI scan was not visualized the thyroid gland. The steroid therapy was started after discontinuation of amiodarone. Three weeks later methimazole and 4 weeks thereafter lithium were started because of the progression in clinical and laboratory findings. Despite current medical therapies, no improvement was detected. Surgical approach was decided. Following of 12 sessions plasmapheresis, fT3: 5.38 pg/ml (2.0–4.4) and fT4: 3.25 ng/dl (0.93–1.7) levels were reduced. Subsequently, total thyroidectomy was performed without perioperative complications. Levothyroxine replacement was started and tapering of steroid therapy was planned. Patient was discharged from hospital by the third day.

Discussion: After the classification of AIT, the appropriate treatment must be started immediately due to high cardiac risk in these patients. Distinguish between two types of AIT is often difficult and usually combined therapy should be started. Persistent treatment choices must be considered in case of refractory to medical treatment.

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