Journal of Endocrinology and Metabolism, ISSN 1923-2861 print, 1923-287X online, Open Access |
Article copyright, the authors; Journal compilation copyright, J Endocrinol Metab and Elmer Press Inc |
Journal website http://www.jofem.org |
Case Report
Volume 5, Number 3, June 2015, pages 220-223
Mixed Amiodarone-Induced Thyrotoxicosis Refractory to Medical Therapy and Plasmapheresis
Figure
Tables
Hormonal investigations | On presentation | After 8 cycles of plasmapheresis | 24 h post-surgery | 72 h post-surgery | Reference range |
---|---|---|---|---|---|
TSH (μIU/mL) | 0.02 | 0.04 | 0.08 | Not tested | 0.28 - 3.89 |
Free T4 (ng/dL) | 4.88 | 4.54 | 3.25 | 1.72 | 0.58 - 1.64 |
Free T3 (pg/mL) | 5.4 | 5.3 | 3.7 | 61 | 2.5 - 3.9 |
Total T3 (ng/dL) | 114 | 111 | 67 | 2.1 | 87 - 178 |
Features of AIT | Type 1 AIT | Type 2 AIT | Mixed AIT |
---|---|---|---|
Mechanism | Excess thyroid hormone synthesis | Excess release of T3, T4 (destructive thyroiditis) | Features of both |
Predisposed thyroid gland | Abnormal | Apparently normal or small goiter | Features of both |
I-123 uptake scan | Most commonly low or low-normal, but sometimes normal or increased | Usually very low | Features of both |
Thyroid ultrasound | Hyper-vascularity | Absent or decreased vascularity | Features of both |
Management | Thionamides Rare need to add potassium perchlorate (not FDA approved) | Anti-inflammatory therapy like prednisone | Combination of both |