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Endocrinology
Refractory amiodarone-induced thyrotoxicosis requiring adjunctive cholestyramine treatment
  1. Huaying Zhao1 and
  2. Joseph MWS Leung1,2
  1. 1 Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
  2. 2 Division of Endocrinology, The University of British Columbia, Vancouver, British Columbia, Canada
  1. Correspondence to Dr Huaying Zhao; huayingz{at}student.ubc.ca

Abstract

Amiodarone is an antiarrhythmic drug which may be associated with thyroid dysfunction. Type I amiodarone-induced thyrotoxicosis (AIT) is treated with thionamides and type II AIT is treated with glucocorticoids. Combined therapy is used in mixed or indeterminate forms. When medical treatment is unsuccessful, radioiodine ablation or thyroidectomy is considered. This report reviews a case of AIT refractory to conventional treatment. Despite high doses of methimazole and prednisone, the patient remained clinically and biochemically thyrotoxic. Cholestyramine, a bile salt sequestrant, was used as an off-label adjunctive treatment resulting in significant improvement and achievement of euthyroidism that may also be in part due to the expected natural timeline of recovery from AIT after several months. The patient subsequently trended towards hypothyroidism with symptomatic weight gain and cold intolerance for which he was initiated on levothyroxine.

  • Thyroid disease
  • Cardiovascular system
  • Endocrine system
  • Drugs: endocrine system

https://doi.org/10.1136/bcr-2024-259860

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    Footnotes

    • Contributors The following authors were responsible for drafting of the text, sourcing and editing of clinical images, investigation results, drawing original diagrams and algorithms, and critical revision for important intellectual content: JMWSL and HZ. The following authors gave final approval of the manuscript: JMWSL and HZ. Is the patient one of the authors of this manuscript? No.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.