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 thyro-toxicosis (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. © 2008 The Japanese Society of Internal Medicine.