cardiovascular-agents and Thyrotoxicosis

Amiodarone-induced thyrotoxicosis (AIT) is a common clinical disorder that may be life threatening and whose clinical manifestations and response to treatment may vary among patients.. We present three patients treated with amiodarone for atrial fibrillation who developed AIT at least 36 months after beginning the treatment. Thyrotoxicosis worsened the underlying cardiac disorders and was resistant to treatment based on the combination of dexamethasone 8-12 mg/day i.v., thioamides 45 mg/day p.o., beta blockers and potassium perchlorate at doses of 800 to 1000 mg per day p.o. Two of the patients attained sustained euthyroidism after 12 and 32 days of combined treatment, while the third required total thyroidectomy.. The combination of thioamides with potassium perchlorate is an appropriate form of therapy for AIT in patients resistant to thioamides. The use of this combination should be evaluated in patients with mixed AIT or AIT of unclear etiology.

Topics: Acenocoumarol; Adrenergic beta-Antagonists; Aged; Aged, 80 and over; Algorithms; Amiodarone; Atrial Fibrillation; Cardiovascular Agents; Comorbidity; Dexamethasone; Drug Therapy, Combination; Female; Humans; Male; Middle Aged; Pacemaker, Artificial; Perchlorates; Potassium Compounds; Thioamides; Thyroid Hormones; Thyroidectomy; Thyrotoxicosis; Thyrotropin

According to some data up to 20% of patients with thyrotoxicosis suffer from vasospastic angina. But presence of coronary artery spasm can be rarely confirmed. We describe a case of development of spasm of coronary arteries in a patients with severe thyrotoxicosis. Despite active treatment of thyrotoxicosis and use of drugs aimed at prevention of coronary spasm this patient with minor changes in coronary arteries (according to autopsy data) developed episode of acute myocardial ischemia leading to lethal outcome. This clinical case shows that patients with thyrotoxicosis and documented transitory myocardial ischemia should receive therapy with thyrostatics and drugs preventing coronary spasm in maximal doses until stable normalization of levels of thyroid hormones.

Topics: Antithyroid Agents; Atrial Fibrillation; Cardiovascular Agents; Coronary Angiography; Electrocardiography; Fatal Outcome; Heart Failure; Humans; Male; Middle Aged; Myocardial Ischemia; Myocardium; Thyrotoxicosis

In black Africa, and particularly in Togo, management of thyreotoxicosis is not simple. The intervention of several specialists and effective patient collaboration is needed. In a majority of cases, the patient's apprehensions, financial problems, and taboos prevent correct management. We report 30 cases of thyreotoxicosis in 82 patients with thyroid disease seen over a 5-year period in the Internal Medicine and Cardiology Department of the Lomé teaching hospitals. Graves' disease was the most frequent (83.33%), followed by multinodular goiter (10%) and toxic nodule (6.67%). Diagnosis was strictly clinical in 53.33% of the cases. The main complication was cardiothyreosis in 46.67% of the patients. Drug treatment was used. Short-term results (4 - 6 weeks) was favorable in 96.67% of the cases. A percentage (65.41%) were lost to follow-up after discharge. The main impairment encountered for the management of thyreotoxicosis was financial and economical difficulties not specific to the disease. Other problems included the lack of diagnostic and therapeutic means and insufficient cooperation between the surgeon, the cardiologist and the endocrinologist.

Topics: Adult; Carbimazole; Cardiovascular Agents; Developing Countries; Drug Therapy, Combination; Exophthalmos; Female; Follow-Up Studies; Goiter, Nodular; Graves Disease; Health Services Needs and Demand; Heart Diseases; Hospitalization; Hospitals, University; Humans; Hypnotics and Sedatives; Interprofessional Relations; Iodine; Male; Patient Care Team; Sweating; Thyroidectomy; Thyrotoxicosis; Togo; Tremor

Topics: Adrenal Cortex Hormones; Calcium; Cardiovascular Agents; Cortisone; Glucocorticoids; Humans; Hypercalcemia; Hyperthyroidism; Prednisone; Thyrotoxicosis