Endocrine Abstracts

JOINT3379

Background: Amiodarone-induced thyrotoxicosis (AIT) is a complication of amiodarone therapy that can be difficult to diagnose and treat, especially in patients with advanced heart failure (HF), because of symptoms that mimic low cardiac output syndrome.

Patient findings: We describe a 19-year-old patient with advanced heart failure due to dilatative cardiomyopathy with surgically implanted left ventricular assist device (LVAD), awaiting heart transplantation. Due to the earlier manifestation of atrial fibrillation (AF), the patient was previously treated with amiodarone, during 18 months, which led to the development of amiodarone-induced thyrotoxicosis (AIT) type 2, as a result of destructive thyroiditis. Despite treatment with various modalities of corticosteroid therapy, AIT was highly resistant to treatment. Due to severe thyrotoxicosis, it was not possible to perform surgical treatment, total thyroidectomy. Prolonged treatment of thyrotoxicosis with various recommended treatment modalities, continuous corticosteroid therapy led to the development of iatrogenic Cushing’s syndrome. Also, at that time, the diagnosis of thrombophilia was made, and heparin-induced thrombocytopenia (HIT) was confirmed.

Conclusion: Treatment of patients with severe HF and LVAD, associated with AIT and associated iatrogenic Cushing’s syndrome, is an endocrinological emergency, with many challenges and requiring a multidisciplinary approach to treatment. AIT is associated with an increased risk of cardiovascular (CV) events, especially in patients with severe HF, so early diagnosis and adequate and timely treatment are very important.