title: Amiodarone-induced myxoedema coma.
abstract: A 62-year-old man was found to have bradycardia, hypothermia and respiratory failure 3 weeks after initiation of amiodarone therapy for atrial fibrillation. Thyroid-stimulating hormone was found to be 168 μIU/mL (nl. 0.3-5 μIU/mL) and free thyroxine (FT4) was <0.2 ng/dL (nl. 0.8-1.8 ng/dL). He received intravenous fluids, vasopressor therapy and stress dose steroids; he was intubated and admitted to the intensive care unit. He received 500 μg of intravenous levothyroxine in the first 18 h of therapy, and 150 µg intravenous daily thereafter. Haemodynamic improvement, along with complete recovery of mental status, occurred after 48 h. Twelve hours after the initiation of therapy, FT4 was 0.96 ng/dL. The patient was maintained on levothyroxine 175 (g POorally daily. A thyroid ultrasound showed diffuse heterogeneity. The 24 hour excretion of iodine was 3657 (mcg (25-756 ( mcg). The only two cases of amiodarone-induced myxoedema coma in the literature report patient death despite supportive therapy and thyroid hormone replacement. This case represents the most thoroughly investigated case of amiodarone-induced myxoedema coma with a history significant for subclinical thyroid disease.
authors.affiliation: Department of Internal Medicine, Henry Ford Hospital, Detroit, Michigan, USA.
authors.forename: Syed
authors.initials: S
authors.lastname: Hassan
authors.forename: Walaa
authors.initials: W
authors.lastname: Ayoub
authors.forename: Mona
authors.initials: M
authors.lastname: Hassan
authors.forename: Max
authors.initials: M
authors.lastname: Wisgerhof
mesh_terms: D000638:Amiodarone / Q000009:adverse effects*; D000889:Anti-Arrhythmia Agents / Q000009:adverse effects*; D003128:Coma / Q000139:chemically induced*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009230:Myxedema / Q000139:chemically induced*
chemical_list: D000889:Anti-Arrhythmia Agents; D000638:Amiodarone
references.citation: Am J Med. 1984 Oct;77(4):751-4
references.pmid: 6486153
references.citation: Lancet. 1994 Aug 20;344(8921):493-8
references.pmid: 7914611
references.citation: Endocrinol Metab Clin North Am. 2006 Dec;35(4):687-98, vii-viii
references.pmid: 17127141
references.citation: Arzneimittelforschung. 1984;34(4):513-20
references.pmid: 6540111
references.citation: Thyroid. 2001 May;11(5):493-500
references.pmid: 11396708
references.citation: J Clin Endocrinol Metab. 1986 Mar;62(3):563-8
references.pmid: 3944239
references.citation: Endocrinology. 1949 Nov;45(5):504-13, illust
references.pmid: 15396709
references.citation: Ann Intern Med. 1984 Jul;101(1):28-34
references.pmid: 6428291
references.citation: Indian Heart J. 2009 Jul-Aug;61(4):392-3
references.pmid: 20635749