title: Differential diagnosis and appropriate treatment of four thyrotoxic patients with Graves' disease required to take amiodarone due to life-threatening arrhythmia.
abstract: We report the treatment of four thyrotoxic patients. Two were cases of type I amiodarone-induced thyrotoxicosis (AIT) treated with methimazole. The third Graves' disease patient, who became hypothyroid 25 years after subtotal thyroidectomy, developed type II AIT. Furthermore, one case with heart failure and ventricular tachycardia, who developed an adverse reaction to antithyroid agents and was prescribed amiodarone, underwent total thyroidectomy. The clinical course was uneventful, and the patient is doing well. Since amiodarone contains a large amount of iodine, it is frequently difficult to make a differential diagnosis. Surgical treatment of Graves' disease patients is recommended when immediate control of hyperthyroidism and heart failure is required.
authors.affiliation: Department of Medicine, Institute of Clinical Endocrinology, Tokyo Women's Medical University, Tokyo. satokan@attglobal.net
authors.forename: Kanji
authors.initials: K
authors.lastname: Sato
authors.forename: Yoko
authors.initials: Y
authors.lastname: Omi
authors.forename: Hitomi
authors.initials: H
authors.lastname: Kodama
authors.forename: Takao
authors.initials: T
authors.lastname: Obara
authors.forename: Kazuko
authors.initials: K
authors.lastname: Yamazaki
authors.forename: Emiko
authors.initials: E
authors.lastname: Yamada
authors.forename: Toshiro
authors.initials: T
authors.lastname: Seki
authors.forename: Kazue
authors.initials: K
authors.lastname: Takano
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Shiga
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kasanuki
mesh_terms: D000328:Adult; D000638:Amiodarone / Q000627:therapeutic use*; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D013956:Antithyroid Agents / Q000009:adverse effects / Q000627:therapeutic use; D001145:Arrhythmias, Cardiac / Q000188:drug therapy*; D003937:Diagnosis, Differential; D006111:Graves Disease / Q000150:complications*; D006801:Humans; D008297:Male; D008713:Methimazole / Q000009:adverse effects / Q000627:therapeutic use*; D008875:Middle Aged; D013965:Thyroidectomy; D013971:Thyrotoxicosis / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*
chemical_list: D000889:Anti-Arrhythmia Agents; D013956:Antithyroid Agents; D008713:Methimazole; D000638:Amiodarone