A 60-year-old man on amiodarone for two years develops weight loss, tremor, and atrial fibrillation. Free T4 is elevated, TSH suppressed, radioactive iodine uptake is near zero, and interleukin-6 levels are markedly raised. The thyroid is non-tender. What is the most appropriate initial treatment?
- A Carbimazole monotherapy
- B Potassium perchlorate
- C Prednisolone ✓
- D Total thyroidectomy
Correct answer: C. Prednisolone
Explanation
Low radioiodine uptake with high interleukin-6 identifies type 2 amiodarone-induced thyrotoxicosis, a destructive thyroiditis caused by direct cytotoxic drug effect on follicular cells. It responds to glucocorticoids such as prednisolone. Type 1 disease, driven by the iodine load in a nodular or Graves gland, shows preserved uptake and responds to thionamides, which makes option A the trap. Surgery is reserved for refractory cases or when cardiac decompensation demands rapid control.
Reference: Williams Textbook of Endocrinology, 14th ed.
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Written and medically reviewed by the StethoPrep medical team.