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What is the amiodarone-induced hypothyroidism?

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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.

What is the amiodarone-induced hypothyroidism?

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Incidence of amiodarone-induced hypothyroidism (AIH) varies widely, ranging from 6% in countries with low iodine intake to 13% in countries with a high-dietary iodine intake. The relative risk of developing AIH was found to be 13-fold higher in female patients with positive thyroid microsomal or thyroglobulin antibodies, as compared with men without thyroid antibodies. Hypothyroidism is usually an early event and it is uncommon after the first 18 months of amiodarone treatment amiodarone-induced hypothyroidism (AIH) is believed to result from the inability of the thyroid to escape from the Wolff-Chaikoff effect. Thyroid hormone biosynthesis is impaired because of the persistent block in intrathyroidal iodine organification, as evident by the positive perchlorate discharge test in patients with AIH. This may arise from an underlying thyroid abnormality, such as autoimmune thyroiditis. 40% of patients who develop hypothyroidism after amiodarone administration have positive thyroid antibodies.

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