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Autoimmune polyglandular syndrome type 2 — SCE Endocrinology MCQ

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HardMEN/NET/MiscellaneousAutoimmune polyglandular syndrome type 2SCE Endocrinology

A man taking amiodarone has new thyrotoxicosis. The gland is not enlarged, TSH-receptor antibodies are negative, colour-flow Doppler shows absent hypervascularity and technetium uptake is negligible. Heart failure is worsening. Which treatment best matches the likely subtype?

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Correct answer: C — Prednisone 30 mg daily for destructive type 2 amiodarone thyrotoxicosis

Explanation lettering: D = shown as B · E = shown as C · B = shown as D · C = shown as E

E is correct. A normal-sized, poorly vascular gland with absent antibodies and negligible uptake supports destructive type 2 amiodarone-induced thyrotoxicosis; ETA guidance recommends oral glucocorticoid, typically prednisone 30 mg/day initially. Thionamide targets new synthesis and is central to type 1 AIT, not pure destructive disease. Negligible uptake makes radioiodine ineffective. Perchlorate is short-term adjunctive therapy for selected type 1 cases, and absent uptake during thyrotoxicosis does not imply hypothyroidism.

Reference: 2018 ETA amiodarone-associated thyroid dysfunction guideline: https://pmc.ncbi.nlm.nih.gov/articles/PMC5869486/