MON-378 - Amiodarone Induced Hypothyroidism in an Elderly Patient with Atrial Fibrillation: A Case Report

Background: Amiodarone is a common medicine used to manage irregular heart rhythms (arrhythmia); however, it is often linked to some side effects. Due to its high iodine content, it can very well damage thyroid function and develop diseases like hypothyroidism and hyperthyroidism. Amiodarone-induced hypothyroidism is a common side effect of the amiodarone, and it affects around 25% of patients receiving it. Despite its commonality, this case describes a unique case of amiodarone-induced hypothyroidism that is complicated by a number of comorbidities, including heart failure, atrial fibrillation, and chronic kidney disease. By its management and treatment, this case will describe the manifestation of AIH in a highly fragile setting (existing with a number of comorbidities). Moreover, this report will shed light on the challenges of diagnosis and management of this complicated case of AIH.

Case Description: The patient is an 87-year-old female who had recently been admitted to the institution due to grade 3 edema. The patient has a history of hypothyroidism, which was initially managed by levothyroxine. However, it was later discontinued due to preference. Aside from hypothyroidism, the patient also has sick sinus syndrome, for which she requires a pacemaker, hypertension, atrial fibrillation, and chronic kidney disease (CKD). The patient has presented typical symptoms of hypothyroidism, like fatigue and cold intolerance. A physical examination also revealed a grade 3 pitting edema. Upon the thyroid function test, amiodarone-induced hypothyroidism is the confirmed diagnosis. Moreover, a 2D echocardiogram revealed heart failure, but it was considered under control with pacemaker therapy. An initial dose of levothyroxine was administered and later increased in dosage because the first doses seemed to be ineffective. Amiodarone was also discontinued, and an alternative strategy was initiated to manage atrial fibrillation. Fluid status was monitored closely, and a follow-up visit is scheduled in two weeks to reassess patient status and improvement.

Conclusion: This case report highlights the necessity of a systematic baseline screening and routine thyroid function tests for every individual, especially those that are predisposed to develop AIH. Moreover, careful monitoring, particularly for patients with other conditions like heart failure, AF, and CKD, is crucial since these individuals may develop a severe case of this condition, and to ensure positive health outcomes. Overall, early recognition, detection, and management are crucial for treating amiodarone-induced hypothyroidism. Moreover, physicians are encouraged to be vigilant in adverse drug effects and patient symptoms. This multifocal strategy is important for the reduction of adverse effects and ensures positive patient outcomes.

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