PMC3648818_01
Echocardiogram in apical four-chamber view of successful surgical closure of secundum atrial septal defect
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The patient had a type II ASD surgical correction 12 months prior to referral (Figure 1).
Twelve-lead electrocardiogram (50 mm/s) showing ectopic atrial tachycardia with cycle length 380 ms (157/min)
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Post-operatively she developed paroxysmal supraventricular (ectopic atrial) tachycardia (Figure 2) and was prescribed amiodarone intravenously, followed by a 100 mg dose orally, two times daily for 6 months.
Thyroid ultrasound 4 weeks after initiation of treatment with ATD: A - In gray scale - uniformly slightly reduced echogenicity of both lobes. B - CFDS - a slight intensification of vascular flow especially in the left lobe
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Color-flow Doppler sonography showed slightly increased intra-thyroidal blood flow especially in the left lobe (Figures 3A, B).
Thyroid ultrasound 7 months after diagnosis, during combination therapy (thionamide + L-thyroxine). A - In gray scale - mildly decreased echogenicity of both lobes. B - PFDS - increased vascular flow
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This contrasts with the image from an examination during the 7th month of treatment (Figures 4A, B) where a heterogeneous thyroid gland with small, yet multiple hypoechogenic areas with increased blood flow (power and color Doppler) was observed - typical of an autoimmune process.
Diagnostic flowchart for evaluating patients with amiodarone-induced thyroid disturbances
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A diagnostic flowchart for evaluating patients with amiodarone-induced thyroid disturbances is presented in Figure 5 and provides a good summary.