{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T16:57:18Z","timestamp":1791219438087,"version":"4.1.0"},"reference-count":18,"publisher":"BMJ","issue":"10","license":[{"start":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T00:00:00Z","timestamp":1791158400000},"content-version":"unspecified","delay-in-days":4,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2026,9,20]]},"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:p>Amiodarone-induced thyrotoxicosis (AIT) is a potentially life-threatening complication of amiodarone therapy, particularly hazardous in patients with underlying structural heart disease. We report the case of a man in his mid-60s with severe cardiomyopathy and recurrent ventricular tachycardia who developed refractory thyrotoxicosis following amiodarone exposure. Overlapping features of type 1 and 2 AIT suggested mixed-type disease, posing a significant diagnostic challenge. Despite aggressive conventional therapy with high-dose thionamides and glucocorticoids, supplemented by adjunctive agents, including lithium and cholestyramine, thyrotoxicosis remained refractory and life-threatening arrhythmias persisted. Given the high cardiac risk and refractory disease course, total thyroidectomy was undertaken as definitive management; therapeutic plasma exchange was used as bridging therapy to achieve rapid biochemical improvement and minimise perioperative risk. This case highlights the complexity of managing severe, treatment-refractory AIT and underscores the value of multidisciplinary care and plasmapheresis as a bridging strategy prior to definitive surgical management.<\/jats:p>","DOI":"10.1136\/bcr-2026-274623","type":"journal-article","created":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T16:10:33Z","timestamp":1791216633000},"page":"e274623","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Refractory amiodarone-induced thyrotoxicosis causing malignant arrhythmias, treated with therapeutic plasma exchange-bridged thyroidectomy"],"prefix":"10.1136","volume":"19","author":[{"given":"Bisma","family":"Nazir","sequence":"first","affiliation":[{"name":"Endocrine and Diabetes, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK"},{"name":"North Manchester General Hospital, Manchester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Myint","family":"Aye","sequence":"additional","affiliation":[{"name":"Endocrine and Diabetes, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasir","family":"Ihsan","sequence":"additional","affiliation":[{"name":"Endocrine and Diabetes, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK"},{"name":"Royal Lancaster Infirmary, Lancaster, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Imran Mehdi","family":"Haidry","sequence":"additional","affiliation":[{"name":"Endocrine and Diabetes, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Inamullah","family":"Khan","sequence":"additional","affiliation":[{"name":"Endocrine and Diabetes, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, 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