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Endocrine Abstracts (2023) 91 CB21 | DOI: 10.1530/endoabs.91.CB21

Department of Diabetes, Endocrinology and Obesity Medicine, Salford Royal NHS Foundation Trust, Salford, United Kingdom

A man in his sixties, with no previous history of thyroid dysfunction (Table 1), was commenced on Amiodarone for atrial fibrillation at the age of 64 years. 24 months after starting on Amiodarone, the patient was found to have a low TSH with markedly elevated fT4 but normal free T3 (fT3). He was asymptomatic, there was no goitre, thyroperoxidase and TSH-receptor antibodies were negative. The thyroid dysfunction was managed by non-interventional observation with gradual resolution (Table 2). Intriguingly, his TSH has now risen above the upper limit of normal with mildly elevated fT4 (Table 3). To exclude assay interference, thyroid function was rechecked on a different laboratory platform (Table 4). An ultrasound scan of the thyroid revealed a slightly bulky thyroid gland with mild heterogeneity and no increased vascularity, suggestive of chronic or subacute thyroiditis.

Table 1 Thyroid function tests (TFTs) prior to commencement of Amiodarone
AgeTSH (0.35-5.50 mU/l) fT4 (10-20 pmol/l)
58•½2.7 9.5
Table 2 Clinical course of TFTs following commencement of Amiodarone
AgeTSH (0.35-5.50 mU/l) fT4 (10-20 pmol/l)fT3 (3.5-6.5 pmol/l)
Table 3 Current TFTs
AgeTSH (0.35-5.50 mU/l)fT4 (10-20 pmol/l)fT3 (3.5-6.5 pmol/l)
Table 4 TFTs checked on a different laboratory platform
AgeTSH (0.35-4.94mU/l)fT4 (9.0-19.0 pmol/l)fT3 (2.43-6.01 pmol/l)

Points for discussion

• Amiodarone-induced thyroid dysfunction?

• Laboratory assay interference?

• Other thoughts?

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