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Amiodarone-induced thyrotoxicosis — ABIM Board MCQ

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HardEndocrinology/MetabolismAmiodarone-induced thyrotoxicosisABIM Board

A 72-year-old taking amiodarone develops weight loss, tremor and palpitations. TSH is suppressed, free T4 is high, radioiodine uptake is low and thyroid Doppler shows low vascularity without nodular autonomous disease. Which diagnosis is most likely?

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Correct answer: D — Amiodarone-induced destructive thyroiditis with low vascularity

The best answer is “Amiodarone-induced destructive thyroiditis with low vascularity”. Type 2 amiodarone thyrotoxicosis is destructive release of preformed hormone, producing low uptake and low vascularity; glucocorticoids are commonly used. Type 1 reflects increased synthesis in abnormal thyroid tissue and tends to show greater vascularity, while Graves disease usually has diffuse hypervascularity.

Reference: 2016 American Thyroid Association Hyperthyroidism Guideline: https://www.thyroid.org/professionals/ata-professional-guidelines/