Mon22November0925AM 3

A 56-year-old male attends the cardiology clinic for review and complains of weight loss, lethargy and diarrhoea. On examination, he is tremulous, tachycardic with a palpable goitre.

His thyroid function tests are as follows

TSH <0.02 mU/L (0.5-5)

Free T4 45 pmol/L (9-23)

Free T3 6.0 pmol/L (3.5-5.5)

Which of these medications is most likely to be responsible for his presentation?

For further information, click on:

Amidarone

Bisoprolol

Flecainide

Ramipril

Simvastatin

(Please select 1 option)

Ramipril

Simvastatin

Amiodarone Correct

Flecainide

Bisoprolol

Explanation

Amiodarone contains iodine and can cause disorders of thyroid function; both hypothyroidism and hyperthyroidism may occur.

Hypothyroidism is more common in areas where iodine intake is normal, and hyperthyroidism more common in areas where iodine intake is low.

Hyperthyroidism can be type 1 when associated with an underlying thyroid abnormality or type 2 where the clinical picture is a thyroiditis.

The condition can be refractory and the drug often has to be discontinued; treatment with carbimazole or propylthiouracil is often required.

Answer Statistics

1

1%

2

2%

3

97%

4

1%

5

2%

Times answered: 267