A case report of surgical treatment of amiodarone-induced thyrotoxicosis in a patient with multiple organ failure

Amiodarone is a drug used in the treatment of life-threatening arrhythmias, which can lead to the development of amiodarone-induced thyrotoxicosis. In most cases this pathology can be treated by conservative methods; surgical treatment is resorted to in cases of thyrotoxicosis refractory to medical treatment. This case report describes surgical treatment of a patient with amiodarone-induced thyrotoxicosis, progressive heart failure, neurological pathology, bilateral pneumonia, functioning tracheostomy, systemic infectious process, multiple organ dysfunction syndrome, who was treated in the intensive care unit. Due to the lack of response to therapy with antithyroid drugs (thiamazole, lithium preparations and pulse therapy with prednisolone) and a progressive deterioration of the condition in a short period of time, according to vital indicators, the patient underwent thyroidectomy. In the postoperative period, there was a decrease in the occurrence of chronic heart failure symptoms. Medical control of cardiac arrhythmias was achieved. Surgical stage proceeded without complications in the period of 30-days. The patient was discharged for outpatient rehabilitation treatment.

1. Trohman RG, Sharma PS, McAninch EA, et al. Amiodarone and thyroid physiology, pathophysiology, diagnosis and management. Trends in cardiovascular medicine. 2019;29(5):285–295. https://doi.org/10.1016/j.tcm.2018.09.005

2. Гринева Е.Н., Цой У.А., Каронова Т.Л. и др. Проект федеральных клинических рекомендаций по диагностике и лечению амиодарон-индуцированной дисфункции щитовидной железы. Клиническая и экспериментальная тиреоидология. 2020;16(2):12–24. https://doi.org/10.14341/ket12693

3. Bartalena L, Bogazzi F, Chiovato L, et al. 2018 European Thyroid Association (ETA) guidelines for the management of amiodarone-associated thyroid dysfunction. Eur Thyroid J. 2018;7(2):55–66. https://doi.org/10.1159/000486957

4. Kotwal A, Clark J, Lyden M, et al. Thyroidectomy for amiodarone-induced thyrotoxicosis: Mayo Clinic Experience. J Endocr Soc. 2018;2(11):1226–1235. https://doi.org/10.1210/js.2018-00259

5. Maqdasy S, Benichou T, Dallel S, et al. Issues in amiodarone-induced thyrotoxicosis: update and review of literature. Ann Endocrinol (Paris). 2019;80(1):54–60. https://doi.org/10.1016/j.ando.2018.05.001

6. Kinoshita S, Hayashi T, Wada K, et al. Risk factors for amiodarone-induced thyroid dysfunction in Japan. Journal of Arrhythmia. 2016;32(6):474–480. https://doi.org/10.1016/j.joa.2016.03.008

7. Houghton SG, Farley DR, Brennan MD, et al. Surgical management of amiodarone-associated thyrotoxicosis: Mayo Clinic experience. World J Surg. 2004;28:1083–1087. https://doi.org/10.1007/s00268-004-7599-6

8. Tomisti L, Materazzi G, Bartalena L, et al. Total thyroidectomy in patients with amiodarone-induced thyrotoxicosis and severe left ventricular systolic dysfunction. J Clin Endocrinol Metab. 2012;97:3515–3521. https://doi.org/10.1210/jc.2012-1797

9. Patel N, Inder WJ, Sullivan C, et al. An audit of amiodaroneinduced thyrotoxicosis – do anti-thyroid drugs alone provide adequate treatment? Heart Lung Circ. 2014;23:549–554. https://doi.org/10.1016/j.hlc.2014.01.013

10. Gough J, Gough IR. Total thyroidectomy for amiodarone-associated thyrotoxicosis in patients with severe cardiac disease. World J Surg. 2006;30:1957–1961. https://doi.org/10.1007/s00268-005-0673-x

11. Isaacs M, Costin M, Bova R, et al. Management of amiodarone-induced thyrotoxicosis at a cardiac transplantation centre. Frontiers in Endocrinology. 2018;9:1–8. https://doi.org/10.3389/fendo.2018.00482

12. Cappellani D, Papini P, Pingitore A, et al. Comparison Between Total Thyroidectomy and Medical Therapy for AmiodaroneInduced Thyrotoxicosis. J Clin Endocrinol Metab. 2020;105(1):242– 251. https://doi.org/10.1210/clinem/dgz041