Amiodarone Causing a Storm

Here are 3 learning points discussed at today's noon conference regarding a patient who presented with VT Storm, found to have Amiodarone Induced Thyrotoxicosis.

1.  VT triggers tend to be a complex interaction between the anatomic substrate (i.e. acute and chronic ischemia, scar of conduction system, heart failure), autonomic tone (i.e. sympathomimetic drugs, thyroiditis, beta blocker withdrawal), and cellular milieu of the myocytes (electrolytes, medications effects, QTc).

2.  Two types of Amiodarone-Induced Thyrotoxicosis exist:
     Type 1: Increased synthesis of T4 & T3 (typically in pts with an underlying multinodular goiter or latent Grave's)
     Type 2: Destructive thyroiditis (via a direct toxic effect on the thyroid follicular epithelial cells)

3.  In type 2 Amiodarone-Induced Thyrotoxicosis, amiodarone can be continued, though it delays restoration of euthyroidism (by a difference of 93 days on average in this study)