Amiodarone-induced thyrotoxicosis (AIT) is a complex endocrine disorder associated with significant morbidity, particularly in patients with underlying cardiac disease. Type 2 AIT, a destructive thyroiditis, is typically managed with corticosteroids. However, treatment becomes challenging when glucocorticoids are contraindicated. We present the case of a 37-year-old male with atrial fibrillation, dilated cardiomyopathy, and McCune-Albright syndrome who developed persistent biochemical thyrotoxicosis while on amiodarone therapy. Despite suppressed thyroid-stimulating hormone and elevated free thyroxine levels, he remained clinically asymptomatic. A thyroid uptake scan demonstrated low uptake consistent with type 2 AIT, although thyroid receptor antibodies were positive, suggesting possible mixed pathology. Management was complicated by coexisting liver lesions, precluding corticosteroid therapy. The patient was managed with low-dose carbimazole, resulting in gradual normalization of thyroid function. This case highlights the complexity of diagnosing and managing AIT and demonstrates that thionamides may be a viable alternative in selected patients in whom corticosteroids are contraindicated, particularly in cases with overlapping features of type 1 and type 2 AIT.
Wasim et al. (Wed,) studied this question.