Mr BK, a 55-year-old male has presented with chief complaints of generalized weakness of 2 months duration, weight loss of two months duration and intermittent palpitation for last 15 days. He is a known case of hypertension on treatment. He had an acute anterior wall myocardial infarction one year ago for which he had to undergo percutaneous transluminal coronary angioplasty. Postcoronary intervention patient developed ventricular tachycardia on three occasions (one in ICU and two times in the ward). For which, he was electroverted and was put on amiodarone (200 mg tablets three times a day since then). Current clinical examination reveals sinus tachycardia with heart rate of 110 per minute, blood pressure is 126/80 mm Hg. He has a grade-1 soft diffuse goiter. On evaluation, his routine hemogram with renal function and liver function tests are normal. His thyroid function test reveals serum T3 of 190 ng/dL (normal range, 80–200 ng/dL), serum T4 of 22 mg/dL (normal range 5.1–14.1 mg/dL) and serum TSH of 0.01 mIU/mL (normal range, 0.27–4.20 mIU/ mL). Serum anti-TPO antibody is within normal range.
How to differentiate between different types of amiodarone-induced thyrotoxicosis?
Although differentiation between the two forms of AIT may not always be feasible, this is useful to determine the most appropriate treatment. Thyroid RAIU study may be helpful in this regard, as the 24-hour uptake is usually normal-to-high in patients with type I AIT and low-to suppressed in type II AIT. The measurement of circulating IL-6 levels also appears to be a promising dis-criminator but this is not widely available. In a recent study, color flow Doppler sonography was found to permit rapid differentiation between the two types of AIT. In the evaluation of 27 consecutive patients, by this technique before starting antithyroid treatment, parenchymal blood flow was demonstrated in all type I AIT patients while it was absent in all type II AIT patients.
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