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      To PLEX or Not to PLEX for Amiodarone-Induced Thyrotoxicosis

      case-report

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          Abstract

          Amiodarone-induced thyrotoxicosis (AIT) carries significant cardiovascular morbidity. There are two types of AIT with treatment including antithyroid medications and corticosteroids and treatment of ventricular arrhythmias. Therapeutic plasma exchange (TPE) also known as “PLEX” may help remove thyroid hormones and amiodarone. We report a case of PLEX in an attempt to treat cardiogenic shock secondary to AIT. This case highlights the robust rapidly deleterious demise of AIT, specifically in patients with decompensated heart failure. The decision to PLEX or not to PLEX for AIT should be individualized, prior to definitive therapy.

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          Most cited references17

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          Life-threatening thyrotoxicosis. Thyroid storm.

          Henry Burch, Leonard Wartofsky (1993)
          Although important strides in recognition and therapy have significantly reduced the mortality in this disorder from the nearly 100% fatality rate noted by Lahey, survival is by no means guaranteed. More recent series have yielded fatality rates between 20% and 50%. Although some authors have attributed this improvement, in part, to a relaxation of the diagnostic criteria for thyroid storm, it more likely represents improvements in early recognition and the beneficial effects of the serial addition of antithyroid, corticosteroid, and antiadrenergic therapies to the treatment of this disorder. Thyroid storm is a dreaded, fortunately rare complication of a very common disorder. Most cases of thyroid storm occur following a precipitating event or intercurrent illness. Effective management is predicated on a prompt recognition of impending thyroid storm which is, in turn, dependent on a thorough knowledge of both the typical and atypical presentations of this disorder. An unwavering commitment to an aggressive, multifaceted therapeutic intervention as outlined herein is critical to the obtainment of a satisfactory outcome.
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            Amiodarone to prevent recurrence of atrial fibrillation. Canadian Trial of Atrial Fibrillation Investigators.

            B Thibault, Debdulal Roy, P Dorian … (2000)
            The restoration and maintenance of sinus rhythm is a desirable goal in patients with atrial fibrillation, because the prevention of recurrences can improve cardiac function and relieve symptoms. Uncontrolled studies have suggested that amiodarone in low doses may be more effective and safer than other agents in preventing recurrence, but this agent has not been tested in a large, randomized trial. We undertook a prospective, multicenter trial to test the hypothesis that low doses of amiodarone would be more efficacious in preventing recurrent atrial fibrillation than therapy with sotalol or propafenone. We randomly assigned patients who had had at least one episode of atrial fibrillation within the previous six months to amiodarone or to sotalol or propafenone, given in an open-label fashion. The patients in the group assigned to sotalol or propafenone underwent a second randomization to determine whether they would receive sotalol or propafenone first; if the first drug was unsuccessful the second agent was prescribed. Loading doses of the drugs were administered and electrical cardioversion was performed (if necessary) within 21 days after randomization for all patients in both groups. The follow-up period began 21 days after randomization. The primary end point was the length of time to a first recurrence of atrial fibrillation. Of the 403 patients in the study, 201 were assigned to amiodarone and 202 to either sotalol (101 patients) or propafenone (101 patients). After a mean of 16 months of follow-up, 71 of the patients who were assigned to amiodarone (35 percent) and 127 of those who were assigned to sotalol or propafenone (63 percent) had a recurrence of atrial fibrillation (P<0.001). Adverse events requiring the discontinuation of drug therapy occurred in 18 percent of the patients receiving amiodarone, as compared with 11 percent of those treated with sotalol or propafenone (P=0.06). Amiodarone is more effective than sotalol or propafenone for the prevention of recurrences of atrial fibrillation.
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              A practical guide for clinicians who treat patients with amiodarone: 2007.

              Nora Goldschlager, Andrew E Epstein, Gerald Naccarelli … (2007)
              Amiodarone is commonly used to treat supraventricular and ventricular arrhythmias in various inpatient and outpatient settings. Over- and under-use of amiodarone is common, and data regarding patterns of use are sparse and largely anecdotal. Because of adverse drug reactions, proper use is essential to deriving optimal benefits from the drug with the least risk. This guide updates an earlier version published in 2000, reviews indications for use of amiodarone and recommends strategies to minimize adverse effects. The recommendations included herein are based on the best available data and the collective experience of the member of the writing committee.
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                Author and article information

                Contributors
                Tania Ahuja:
                ORCID: https://orcid.org/0000-0003-1833-4124
                Journal
                Journal ID (nlm-ta): Case Rep Cardiol
                Journal ID (iso-abbrev): Case Rep Cardiol
                Journal ID (publisher-id): CRIC
                Title: Case Reports in Cardiology
                Publisher: Hindawi
                ISSN (Print): 2090-6404
                ISSN (Electronic): 2090-6412
                Publication date Collection: 2023
                Publication date (Electronic): 20 November 2023
                Volume: 2023
                Electronic Location Identifier: 1563732
                Affiliations
                1Department of Medicine, The Leon H. Charney Division of Cardiology, New York University Grossman School of Medicine, USA
                2Department of Pharmacy, New York University Langone Health, New York, New York 10016, USA
                3Department of Advanced Practice Practitioners, New York University Langone Health, New York, New York 10016, USA
                Author notes

                Academic Editor: Yi Yan

                Author information
                https://orcid.org/0000-0003-1833-4124
                https://orcid.org/0000-0002-3808-3273
                Article
                DOI: 10.1155/2023/1563732
                PMC ID: 10681774
                PubMed ID: 38026474
                SO-VID: f6e25c25-2924-4d53-b3ea-18e11e12f3b5
                Copyright © Copyright © 2023 Tania Ahuja et al.
                License:

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 21 March 2023
                Date revision received : 27 October 2023
                Date accepted : 7 November 2023
                Categories
                Subject: Case Report

                Data availability:

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