When amiodarone-induced thyroiditis meets cardiomyopathy with excessive trabeculation: a case report
IntroductionAmiodarone is a potent antiarrhythmic medication used to treat life-threatening ventricular arrhythmias; however, its well-established adverse effect is a thyroid disorder. Amiodarone-induced thyroiditis (AIT), a clinical entity involving two types with different etiopathology and treatm...
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| Language: | English |
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Frontiers Media S.A.
2023-07-01
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| Series: | Frontiers in Cardiovascular Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fcvm.2023.1212965/full |
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| author | Dora Gašparini Dora Gašparini Damir Raljević Damir Raljević Vesna Pehar-Pejčinović Vesna Pehar-Pejčinović Tihana Klarica Gembić Viktor Peršić Viktor Peršić Tamara Turk Wensveen Tamara Turk Wensveen Tamara Turk Wensveen |
| author_facet | Dora Gašparini Dora Gašparini Damir Raljević Damir Raljević Vesna Pehar-Pejčinović Vesna Pehar-Pejčinović Tihana Klarica Gembić Viktor Peršić Viktor Peršić Tamara Turk Wensveen Tamara Turk Wensveen Tamara Turk Wensveen |
| author_sort | Dora Gašparini |
| collection | DOAJ |
| description | IntroductionAmiodarone is a potent antiarrhythmic medication used to treat life-threatening ventricular arrhythmias; however, its well-established adverse effect is a thyroid disorder. Amiodarone-induced thyroiditis (AIT), a clinical entity involving two types with different etiopathology and treatment approaches, may occur at the beginning or even several years after amiodarone treatment discontinuation. The toxicity profile of amiodarone becomes especially important in young patients with lifelong cardiac disorders, which are often refractory to other antiarrhythmic drugs. Herein, we report the first case of non-sustained ventricular tachycardia (NSVT), an unusual presentation of type II AIT, in a young male patient who was previously diagnosed with left ventricular cardiomyopathy with excessive trabeculation.Case reportA 36-year-old male non-athlete presented with tiredness during regular follow-up. Continuous electrocardiographic monitoring (cECG) revealed NSVT, whereas echocardiography and cardiac magnetic resonance imaging detected discrete structural and functional changes that could not fully explain the observed cECG report. Conversely, an unmeasurably low thyrotropin level on admission and previous exposure to amiodarone pointed the diagnostic pathway in the direction of the thyroid gland. Elevated free thyroxine and undetectable autoantibody titers with unremarkable sonographic findings raised clinical suspicion of type II AIT. Scintigraphic imaging with 99mTc-2-methoxyisobutylisonitrile (sestamibi) revealed decreased thyroid uptake; hence, prednisone was introduced for treatment. Clear improvements in both biochemical and electrocardiographic parameters were observed after immunomodulatory treatment of type II AIT in this young patient with cardiomyopathy and excessive trabeculation.ConclusionTreatment of reversible causes of cardiac rhythm abnormalities such as type II AIT should be considered before choosing other treatment modalities, particularly in patients with structural cardiac disorders. The importance of a multidisciplinary approach in complex cases such as the one reported, thus, cannot be emphasized enough. |
| first_indexed | 2024-03-12T22:28:26Z |
| format | Article |
| id | doaj.art-2e65f5d7d39345f793a0e80e29af63a5 |
| institution | Directory Open Access Journal |
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| language | English |
| last_indexed | 2024-03-12T22:28:26Z |
| publishDate | 2023-07-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Cardiovascular Medicine |
| spelling | doaj.art-2e65f5d7d39345f793a0e80e29af63a52023-07-21T18:47:16ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2023-07-011010.3389/fcvm.2023.12129651212965When amiodarone-induced thyroiditis meets cardiomyopathy with excessive trabeculation: a case reportDora Gašparini0Dora Gašparini1Damir Raljević2Damir Raljević3Vesna Pehar-Pejčinović4Vesna Pehar-Pejčinović5Tihana Klarica Gembić6Viktor Peršić7Viktor Peršić8Tamara Turk Wensveen9Tamara Turk Wensveen10Tamara Turk Wensveen11Department of Histology and Embryology, Faculty of Medicine, University of Rijeka, Rijeka, CroatiaCenter for Diabetes, Endocrinology and Cardiometabolism, Hospital for Medical Rehabilitation of the Heart and Lung Diseases and Rheumatism Thalassotherapia Opatija, Opatija, CroatiaDepartment of Rehabilitation and Sports Medicine, Faculty of Medicine, University of Rijeka, Rijeka, CroatiaDivision of Cardiology, Hospital for Medical Rehabilitation of the Heart and Lung Diseases and Rheumatism Thalassotherapia Opatija, Opatija, CroatiaDepartment of Rehabilitation and Sports Medicine, Faculty of Medicine, University of Rijeka, Rijeka, CroatiaDivision of Cardiology, Hospital for Medical Rehabilitation of the Heart and Lung Diseases and Rheumatism Thalassotherapia Opatija, Opatija, CroatiaDepartment for Nuclear Medicine, Clinical Hospital Center Rijeka, Rijeka, CroatiaDepartment of Rehabilitation and Sports Medicine, Faculty of Medicine, University of Rijeka, Rijeka, CroatiaDivision of Cardiology, Hospital for Medical Rehabilitation of the Heart and Lung Diseases and Rheumatism Thalassotherapia Opatija, Opatija, CroatiaCenter for Diabetes, Endocrinology and Cardiometabolism, Hospital for Medical Rehabilitation of the Heart and Lung Diseases and Rheumatism Thalassotherapia Opatija, Opatija, CroatiaDepartment of Internal Medicine, Faculty of Medicine, University of Rijeka, Rijeka, CroatiaDepartment of Endocrinology, Diabetes and Metabolic Diseases, Clinic of Internal Medicine, Clinical Hospital Center Rijeka, Rijeka, CroatiaIntroductionAmiodarone is a potent antiarrhythmic medication used to treat life-threatening ventricular arrhythmias; however, its well-established adverse effect is a thyroid disorder. Amiodarone-induced thyroiditis (AIT), a clinical entity involving two types with different etiopathology and treatment approaches, may occur at the beginning or even several years after amiodarone treatment discontinuation. The toxicity profile of amiodarone becomes especially important in young patients with lifelong cardiac disorders, which are often refractory to other antiarrhythmic drugs. Herein, we report the first case of non-sustained ventricular tachycardia (NSVT), an unusual presentation of type II AIT, in a young male patient who was previously diagnosed with left ventricular cardiomyopathy with excessive trabeculation.Case reportA 36-year-old male non-athlete presented with tiredness during regular follow-up. Continuous electrocardiographic monitoring (cECG) revealed NSVT, whereas echocardiography and cardiac magnetic resonance imaging detected discrete structural and functional changes that could not fully explain the observed cECG report. Conversely, an unmeasurably low thyrotropin level on admission and previous exposure to amiodarone pointed the diagnostic pathway in the direction of the thyroid gland. Elevated free thyroxine and undetectable autoantibody titers with unremarkable sonographic findings raised clinical suspicion of type II AIT. Scintigraphic imaging with 99mTc-2-methoxyisobutylisonitrile (sestamibi) revealed decreased thyroid uptake; hence, prednisone was introduced for treatment. Clear improvements in both biochemical and electrocardiographic parameters were observed after immunomodulatory treatment of type II AIT in this young patient with cardiomyopathy and excessive trabeculation.ConclusionTreatment of reversible causes of cardiac rhythm abnormalities such as type II AIT should be considered before choosing other treatment modalities, particularly in patients with structural cardiac disorders. The importance of a multidisciplinary approach in complex cases such as the one reported, thus, cannot be emphasized enough.https://www.frontiersin.org/articles/10.3389/fcvm.2023.1212965/fullamiodaronecase reportisolated noncompaction of the ventricular myocardiumprednisoneventricular tachycardia |
| spellingShingle | Dora Gašparini Dora Gašparini Damir Raljević Damir Raljević Vesna Pehar-Pejčinović Vesna Pehar-Pejčinović Tihana Klarica Gembić Viktor Peršić Viktor Peršić Tamara Turk Wensveen Tamara Turk Wensveen Tamara Turk Wensveen When amiodarone-induced thyroiditis meets cardiomyopathy with excessive trabeculation: a case report Frontiers in Cardiovascular Medicine amiodarone case report isolated noncompaction of the ventricular myocardium prednisone ventricular tachycardia |
| title | When amiodarone-induced thyroiditis meets cardiomyopathy with excessive trabeculation: a case report |
| title_full | When amiodarone-induced thyroiditis meets cardiomyopathy with excessive trabeculation: a case report |
| title_fullStr | When amiodarone-induced thyroiditis meets cardiomyopathy with excessive trabeculation: a case report |
| title_full_unstemmed | When amiodarone-induced thyroiditis meets cardiomyopathy with excessive trabeculation: a case report |
| title_short | When amiodarone-induced thyroiditis meets cardiomyopathy with excessive trabeculation: a case report |
| title_sort | when amiodarone induced thyroiditis meets cardiomyopathy with excessive trabeculation a case report |
| topic | amiodarone case report isolated noncompaction of the ventricular myocardium prednisone ventricular tachycardia |
| url | https://www.frontiersin.org/articles/10.3389/fcvm.2023.1212965/full |
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