Plasmapheresis as a bridge to thyroidectomy in a patient with severe type II amiodarone-induced thyrotoxicosis, ischemic cardiomyopathy, and refractory VT

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Case description

A 64-year-old man with ischemic cardiomyopathy and an implantable cardiac defibrillator (ICD) presented with symptoms of thyrotoxicosis. He was found to be dysrhythmic with new atrial fibrillation (AF) and ventricular tachycardia (VT). Amiodarone therapy was stopped 3 months earlier. The thyroid profile was grossly deranged with negative thyroid autoantibodies. A diagnosis of type 2 AIT was made. Despite aggressive and maximal medical therapy, the patient remained thyrotoxic with persistent unstable cardiac arrhythmia. Multidisciplinary evaluation favored emergency thyroidectomy. The patient underwent plasmapheresis with excellent reduction in T₄ levels, followed by successful thyroidectomy. All antithyroid drugs were stopped and amiodarone was restarted. Pathology results confirmed AIT. The patient remains well and arrhythmia-free at 4 months follow-up.

About Best Case Report Contest 2024

Young Talents in Internal Medicine World Contest—previously Best Case Report Contest—is a contest for internal medicine specialists or trainees in internal medicine up to 35 years of age. Every year the most engaging submissions from around the world are presented by authors during a special session at the McMaster International Review Conference of Internal Medicine (MIRCIM). Visit youngtalents.one to learn more.

To browse all abstracts from Best Case Report Contest 2024, visit Polish Archives of Internal Medicine.