{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T19:10:06Z","timestamp":1756321806619,"version":"3.44.0"},"reference-count":11,"publisher":"BMJ","issue":"9","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2024,8,22]]},"published-print":{"date-parts":[[2024,9]]},"abstract":"<jats:p>Amiodarone is an antiarrhythmic drug which may be associated with thyroid dysfunction. Type I amiodarone-induced thyrotoxicosis (AIT) is treated with thionamides and type II AIT is treated with glucocorticoids. Combined therapy is used in mixed or indeterminate forms. When medical treatment is unsuccessful, radioiodine ablation or thyroidectomy is considered. This report reviews a case of AIT refractory to conventional treatment. Despite high doses of methimazole and prednisone, the patient remained clinically and biochemically thyrotoxic. Cholestyramine, a bile salt sequestrant, was used as an off-label adjunctive treatment resulting in significant improvement and achievement of euthyroidism that may also be in part due to the expected natural timeline of recovery from AIT after several months. The patient subsequently trended towards hypothyroidism with symptomatic weight gain and cold intolerance for which he was initiated on levothyroxine.<\/jats:p>","DOI":"10.1136\/bcr-2024-259860","type":"journal-article","created":{"date-parts":[[2024,9,4]],"date-time":"2024-09-04T01:00:32Z","timestamp":1725411632000},"page":"e259860","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Refractory amiodarone-induced thyrotoxicosis requiring adjunctive cholestyramine treatment"],"prefix":"10.1136","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-0330-5906","authenticated-orcid":false,"given":"Huaying","family":"Zhao","sequence":"first","affiliation":[{"name":"Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3124-3692","authenticated-orcid":false,"given":"Joseph MWS","family":"Leung","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada"},{"name":"Division of Endocrinology, The University of British Columbia, Vancouver, British Columbia, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2024,9,3]]},"reference":[{"key":"2025082711440356000_17.9.e259860.1","doi-asserted-by":"crossref","first-page":"579","DOI":"10.4414\/smw.2003.10296","article-title":"Management of amiodarone-induced thyrotoxicosis","volume":"133","author":"Rajeswaran","year":"2003","journal-title":"Swiss Med Wkly"},{"key":"2025082711440356000_17.9.e259860.2","unstructured":"Kaplan JA . Essentials of Cardiac Anesthesia for Noncardiac Surgery: A Companion to Kaplan\u2019s Cardiac Anesthesia. Elsevier Health Sci 2018."},{"key":"2025082711440356000_17.9.e259860.3","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.0000027586.64231.1B"},{"key":"2025082711440356000_17.9.e259860.4","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1159\/000486957","article-title":"2018 European Thyroid Association (ETA) Guidelines for the Management of Amiodarone-Associated Thyroid Dysfunction","volume":"7","author":"Bartalena","year":"2018","journal-title":"Eur Thyroid J"},{"key":"2025082711440356000_17.9.e259860.5","doi-asserted-by":"crossref","unstructured":"Turner HE , Eastell R , Grossman A . Endocrinology (oxford desk reference). 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