FAILURE OF PLASMAPHERESIS, CORTICOSTEROIDS AND THIONAMIDES TO AMELIORATE A CASE OF PROTRACTED AMIODARONE-INDUCED THYROIDITIS

We report a case of amiodarone-induced thyrotoxicosis of protracted du ration, unresponsive to conventional thionamide therapy, with therapy limited by severe adverse drug reactions, Other treatment modalities i ncluded high dose corticosteroids, plasmapheresis, lithium and perchlo rate. Temporary amelioration was achieved following plasmapheresis; ho wever, this and other measures were unsuccessful in controlling the th yrotoxicosis, which deteriorated to thyroid storm, Histopathologically , a degenerative, inflammatory thyroiditis was evident, We discuss the limitations of conventional drug therapy and the lack of a sustained response to plasmapheresis, The failure of high dose steroids to alter the course of illness and to completely suppress the thyroidal inflam matory process is highlighted, A potential role for renal and hepatic impairment in the observed protracted course of amiodarone-induced thy rotoxicosis is suggested.