{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T23:08:09Z","timestamp":1774566489018,"version":"3.50.1"},"reference-count":22,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2026,2,23]],"date-time":"2026-02-23T00:00:00Z","timestamp":1771804800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,2,23]],"date-time":"2026-02-23T00:00:00Z","timestamp":1771804800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Case Reports"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>\n                    Amiodarone therapy may induce thyroid dysfunction in approximately 20% of patients, either amiodarone\u2010induced hypothyroidism (AIH) or thyrotoxicosis (AIT). Both situations may occur at any time during treatment or even months to years after drug withdrawal due to tissue storage with slow systemic release. The sequential occurrence of severe AIH followed by late\u2010onset AIT, particularly type 1, is exceptionally uncommon. We report the case of a 76\u2010year\u2010old woman, with long\u2010standing amiodarone therapy for atrial fibrillation who presented in the emergency department with lethargy, hypothermia, bradycardia, respiratory and renal failure, and severe biochemical hypothyroidism. A Popoveniuc score of 90 points supported the diagnosis of myxedema coma, and intravenous levothyroxine plus hydrocortisone therapy was initiated. She presented favorable evolution with all dysfunctions' resolution and was discharged under 150\u2009\u03bcg levothyroxine; amiodarone was discontinued after Cardiology's assessment. Thyroid function normalized under gradually reduced levothyroxine dosing, which was ultimately suspended fourteen months later. Thirty\u2010two months after amiodarone suspension, the patient developed persistent biochemical hyperthyroidism with negative thyroid autoimmunity.\n                    <jats:sup>99m<\/jats:sup>\n                    Tc\u2010pertechnetate scintigraphy showed diffuse uptake, compatible with type 1 AIT. Methimazole therapy was initiated, and the patient presented a gradual recovery of thyroid function. This case illustrates the full spectrum of amiodarone\u2010induced thyroid dysfunction, from life\u2010threatening AIH to late\u2010onset type 1 AIT long after drug withdrawal. It underscores the prolonged metabolic consequences of amiodarone exposure, the possibility of sequential opposing thyroid dysfunction states, and the necessity for extended surveillance even years after cessation.\n                  <\/jats:p>","DOI":"10.1002\/ccr3.72158","type":"journal-article","created":{"date-parts":[[2026,3,8]],"date-time":"2026-03-08T21:45:28Z","timestamp":1773006328000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Sequential Amiodarone\u2010Induced Thyroid Dysfunction: From Myxedema Coma to Late\u2010Onset Type 1 Thyrotoxicosis After Drug Withdrawal"],"prefix":"10.1002","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4401-2727","authenticated-orcid":false,"given":"Daniela M.","family":"Soares","sequence":"first","affiliation":[{"name":"Endocrinology Department \u2013 Unidade Local de Sa\u00fade de Santo Ant\u00f3nio  Porto Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lia","family":"Ferreira","sequence":"additional","affiliation":[{"name":"Endocrinology Department \u2013 Unidade Local de Sa\u00fade de Santo Ant\u00f3nio  Porto Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2026,2,23]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.1159\/000486957"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.2165\/00003088-198409020-00002"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1159\/000180696"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0021-9258(18)57335-X"},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.1210\/jcem-32-4-515"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.1089\/thy.1998.8.83"},{"key":"e_1_2_13_8_1","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2010-0180"},{"key":"e_1_2_13_9_1","doi-asserted-by":"publisher","DOI":"10.1210\/er.22.2.240"},{"key":"e_1_2_13_10_1","doi-asserted-by":"publisher","DOI":"10.1253\/circj.CJ-13-0220"},{"key":"e_1_2_13_11_1","doi-asserted-by":"publisher","DOI":"10.15605\/jafes.034.S60"},{"key":"e_1_2_13_12_1","first-page":"P332","article-title":"A Case of Amiodarone Induced Thyrotoxicosis, Type II Followed by Subsequent Hypothyroidism","volume":"25","author":"McElwaine F.","year":"2011","journal-title":"Endocrine Abstracts"},{"key":"e_1_2_13_13_1","doi-asserted-by":"publisher","DOI":"10.4158\/EP13460.OR"},{"key":"e_1_2_13_14_1","first-page":"327","article-title":"Amiodarone and Thyroid Dysfunction","volume":"61","author":"Medi\u0107 F.","year":"2022","journal-title":"Acta Clinica Croatica"},{"key":"e_1_2_13_15_1","unstructured":"P.BuiandM.Lazarus Amiodarone Induced Myxedema Coma Proceedings of UCLA Healthcare 2016 volume 20."},{"issue":"6","key":"e_1_2_13_16_1","article-title":"Amiodarone\u2010Induced Myxedema Coma in Elderly Patients: A Systematic Review of Case Reports","volume":"15","author":"Alnaeem M. M.","year":"2023","journal-title":"Cureus"},{"key":"e_1_2_13_17_1","article-title":"Amiodarone\u2010Induced Myxedema Coma","volume":"12","author":"Raeouf A.","year":"2020","journal-title":"Cureus"},{"key":"e_1_2_13_18_1","doi-asserted-by":"publisher","DOI":"10.1530\/EJE-14-0267"},{"key":"e_1_2_13_19_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00394-023-03149-1"},{"key":"e_1_2_13_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(23)02016-0"},{"issue":"2","key":"e_1_2_13_21_1","article-title":"Amiodarone Induced Thyrotoxicosis in Previously Sub Clinically Hypothyroid Patient on Amiodarone \u2013 Case Report","volume":"3","author":"Aleksi\u0107 \u017d.","year":"2016","journal-title":"Journal of Drug Design Research"},{"issue":"3","key":"e_1_2_13_22_1","first-page":"205","article-title":"Amiodarone Induced Thyrotoxicosis (AIT) Type 2 Several Months After Withdrawal of Amiodarone Therapy","volume":"29","author":"Aleksi\u0107 \u017d.","year":"2004","journal-title":"Journal of Regional Section of Serbian Medical Association in Zajecar"},{"issue":"44","key":"e_1_2_13_23_1","first-page":"2110","article-title":"Hypothyroidism Followed by Hyperthyroidism Under Treatment With Amiodarone","volume":"123","author":"Martin\u2010Du Pan R. C.","year":"1993","journal-title":"Schweizerische Medizinische Wochenschrift"}],"container-title":["Clinical Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ccr3.72158","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/ccr3.72158","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ccr3.72158","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T06:06:50Z","timestamp":1774505210000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/ccr3.72158"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,23]]},"references-count":22,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026,3]]}},"alternative-id":["10.1002\/ccr3.72158"],"URL":"https:\/\/doi.org\/10.1002\/ccr3.72158","archive":["Portico"],"relation":{},"ISSN":["2050-0904","2050-0904"],"issn-type":[{"value":"2050-0904","type":"print"},{"value":"2050-0904","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,23]]},"assertion":[{"value":"2025-12-01","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-02-14","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-02-23","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e72158"}}