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Case Reports
. 2018 Jan 1;57(1):59-63.
doi: 10.2169/internalmedicine.9177-17. Epub 2017 Oct 16.

Amiodarone-induced Thyrotoxicosis with Cardiopulmonary Arrest

Kosuke Inoue  1 , Jun Saito  1 , Tetsuo Kondo  2 , Kaoru Miki  3 , Chiho Sugisawa  1 , Yuya Tsurutani  1 , Naoki Hasegawa  4 , Shinya Kowase  5 , Yukio Kakuta  4 , Masao Omura  1 , Tetsuo Nishikawa  1
Affiliations
Case Reports

Amiodarone-induced Thyrotoxicosis with Cardiopulmonary Arrest

Kosuke Inoue et al. Intern Med. .

Abstract

We describe a case of amiodarone-induced thyrotoxicosis (AIT) with cardiopulmonary arrest (CPA) in a 49-year-old woman. The patient had been treated with amiodarone for non-sustained ventricular tachycardia. Two weeks prior to her admission, she developed thyrotoxicosis and prednisolone (PSL, 30 mg daily) was administered with the continuation of amiodarone. However, she was admitted to our hospital for CPA. We performed total thyroidectomy to control her thyrotoxicosis and the pathological findings were consistent with type 2 AIT. She gradually improved and was discharged on day 84. This case demonstrates the importance of considering immediate total thyroidectomy for patients with uncontrollable AIT.

Keywords: amiodarone-induced thyrotoxicosis; cardiopulmonary arrest; hyperthyroxinemia; prednisolone; thyroidectomy.

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Figures

Figure 1.
Figure 1.
Thyroid ultrasound. Right lobe, 2.2 (wide) ×2.7 (depth) ×7.5 (length) cm; left lobe, 2.1×2.4×7.4 cm; Isthmus, 0.36×3.1 cm. The thyroid volume, as calculated by the ellipsoid formula, was 43.5 cm3. Color flow Doppler sonography revealed no intraparenchymal vascularity.
Figure 2.
Figure 2.
The pathological findings of the thyroid. Atrophic follicles with interstitial fibrosis [a and b: Hematoxylin and Eosin (H&E) staining]. Disrupted follicles with detachment of the follicular epithelium and the macrophage infiltration (c: H&E staining). Cytoplasmic vacuolization and lipofuscin in flattened follicular epithelial cells (d: H&E staining).
Figure 3.
Figure 3.
The clinical course. Two weeks after the administration of prednisolone (PSL) for amiodarone-induced thyrotoxicosis, she had an episode of cardiopulmonary arrest (CPA). Total thyroidectomy was performed on day 7 to treat her uncontrolled hyperthyroxinemia. After resection, her thyroid hormone levels gradually decreased. The PSL dose was tapered and levothyroxine was started. Amiodarone was continued to control her non-sustained ventricular tachycardia (NSVT). After rehabilitation, she finally discharged on day 84.
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