J Korean Endocr Soc.  2007 Jun;22(3):229-234. 10.3803/jkes.2007.22.3.229.

Amiodarone Induced Thyrotoxicosis (Type II)

• Ju CY
• Kim HK
• Chung HJ
• Park YJ
• Kim JY
• Jung SM
• Choi SJ
• Kang GH
• Shim MS

• KMID: 1512037
• DOI: http://doi.org/10.3803/jkes.2007.22.3.229

Abstract

Amiodarone is an iodinated benzofuran derivative, that is highly effective as an agent for the treatment of various cardiac arrhythmias; these arrthymias, range from paroxysmal atrial fibrillation to life-threatening ventricular tachyarrhythmias. Yet amiodarone is associated with several side effects that include dysfunction of liver, thyroid or various other organs. Two main forms of amiodarone induced thyrotoxicosis (AIT) have been described; type I AIT develops in an abnormal thyroid gland (nodular goiter, latent Graves' disease) and it is due to amiodarone-induced true hyperthyroidism; type II AIT occurs in an apparently normal thyroid gland and it is due to amiodarone-induced destructive thyroiditis. We recently experienced a case of type II thyrotoxicosis that was induced by amiodarone treatment for ventricular tachycardia after acute myocardial infarction. The symptoms of thyrotoxicosis were relieved after withdrawal of amiodarone and administering steroid. Type I AIT has often been reported on but type II AIT is relatively rare. We report here on a case of type II amiodarone induced thyrotoxicosis along with a literature review.

Keyword

Amiodarone; Amiodarone induced thyrotoxicosis; Hyperthyroidism

MeSH Terms

Amiodarone*
Arrhythmias, Cardiac
Atrial Fibrillation
Goiter
Hyperthyroidism
Liver
Myocardial Infarction
Tachycardia
Tachycardia, Ventricular
Thyroid Gland
Thyroiditis
Thyrotoxicosis*
Amiodarone

Figure

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  Fig. 1 Thyroid scan (99mTcO4). Non-visualization of both lobes (decreased 99mTcO4 uptake).

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  Fig. 2 Color doppler ultrasound. It shows diffusely diminished vascularity in the parenchyma of the thyroid gland.

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  Fig. 3 Cytologic finding of the thyroid gland. There are multinucleated giant cells phagocytising colloid, mononuclear macrophages and a few lymphocytes in the smear slide of aspiration. (Pap stain, ×100)

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  Fig. 4 Abdominal CT scan without contrast enhancement. It shows increased density of the liver parenchyma compared to that of the spleen due to amiodarone toxicity.

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  Fig. 5 Serial measurement of thyroid stimulating hormone and free thyroxine.

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