Endocrine Abstracts

A 41 year old female, followed up closely by cardiology in view of grown up congenital heart disease secondary to tricuspid atresia, pulmonary stenosis and atrial septal defect in infacy, and brittle paroxysmal atrial fibrillation (AF) was noted to be progressively lethargic and anorexic. She also developed bilateral lower limb oedema and was admitted for further investigation of decompensated congestive heart failure (CHF). Overt thyrotoxicosis was found on investigation. Since the patient had been on Amiodarone for five years, a diagnosis of Amiodarone-induced thyroiditis (AIT) was made and the endocrinology team was involved. At initial assessment, the patient was noted to be anxious, emotionally labile, tremulous and had a resting sinus tachycardia. Thyroid examination also revealed a goitre. The patient’s main concern was the decompensation in heart failure and the possibiltiy of rebound atrial fibrillation off treatment. There was no past history of thyroid disease. Initial treatment included 40 mg of prednisolone (Pred) and 40 mg of carbimazole (CBZ) daily and 10 mg Propranolol three times daily. Cardiologists were also concerned regarding steroid use in view of the risk of further decompensation of CHF. Autoimmune serology and a thyroid ultrasound were done to better elucidate if AIT Type 1 (antithyroid agent responsive) or AIT Type 2 (steroid responsive) was the cause. Results are shown in table 1 below. Whereas immunology was consistent with AIT Type 1, Ultrasonography favoured AIT Type 2. The patient was therefore kept on both Carbimazole and Prednisolone with clinical response showing a slow course and therefore favouring AIT Type 1. The patient improved clinically and biochemically over a 4 month period with results shown below in table 2.