Vnitr Lek 2024, 70(4):E8-E15

Thyrotoxic crisis induced by amiodarone

Marianna Bystrianska¹, Adrian Bystriansky², Iveta Wildová¹, Lýdia Opravilová¹

¹ II. interná klinika SZU, FNsP F. D. R. Banská Bystrica

² II. klinika kardiológie a Oddelenie arytmií SÚSCCH, Banská Bystrica

Background: Thyrotoxic crisis is a medical emergency status needed rapid diagnostic and urgent treatment, presented by decompensation and multiorgan dysfunction. Amiodarone induced thyrotoxicosis (AIT) is one of the severe complications caused by amiodarone therapy.

Aim: Analysis of patients suffered from thyrotoxic crisis induced by Amiodarone therapy, with focus on clinical picture, laboratory findings and therapeutic options.

Methods and Results: A total of 39 consecutive patients were dispensed to the Endocrine outpatient clinic of the University Hospital Banská Bystrica, with AIT during the period of 2005-2021 year we performed retrospective analysis of 5 consecutive patients with thyrotoxic crisis, who have been hospitalized on department of Internal Medicine University Hospital Banska Bystrica. All of patients were men (mean age 56,0 ± 5,4 years), All of analysed patients (n = 5) have been treated for arterial hypertension, 20% (n = 1) ischemic heart disease, 60% (n = 3) had medical history of heart failure and 40% (n = 2) had implantable cardioverter defibrillator. Indication for Amiodarone therapy was atrial fibrillation (n = 2) and ventricular tachyarrhythmias (n = 3). The average time of use of amiodarone until development AIT was 1005 ± 199 days. Mean TSH in the time of diagnosis was 0,005 ± 0,008 mIU/L and mean free T4 was 52,1 ± 14,3 pmol/L. Mean volume of thyroid gland was 19,8 ± 5,8 ml and mean Burch-Wartofsky Score was 86 ± 18. Three patients have been diagnosed as mixed type AIT and the two as AIT type 2. Diagnosis was made on the basis of clinical, laboratory and imaging examinations. All of the patients (n=5) have been treated with antithyroid drugs and corticosteroids at the maximum recommended doses. 80% (n=4) underwent urgently thyroidectomy and one was threated conservatively. The thyroid papillary micro adenocarcinoma was histologically confirmed in 1 of the observed patients.

Conclusion: Thyrotoxic crisis induced by Amiodarone is an endocrine emergency which is characterized by multiple organs failure due to sever thyrotoxicosis.

Keywords: amiodarone, thyrotoxic crisis.

Accepted: June 12, 2024; Published: June 20, 2024  Show citation