Aritmia ventricolare dovuta a tireotossicosi indotta da amiodarone: un rischio anche a distanza

Management of dilated cardiomyopathy in children and adolescents may be challenging, not only for the treatment of heart failure but for also the management of complex arrhythmias. Amiodarone is widely used for arrhythmia control in patients with impaired left ventricular ejection fraction. Its well-documented side effects include pulmonary and thyroid toxicity. Even after discontinuation of the drug, delayed-onset hyperthyroidism with potentially life-threatening clinical presentation may occur, a condition that highlights the need for continuous and long-term monitoring. The paper reports a complex case of adverse effects to anti-arrhythmic therapy in a female patient with genetically determined dilated cardiomyopathy (DCM) carrying a heterozygous PRDM16 mutation. The patient developed severe hyperthyroidism associated with ventricular arrhythmia nine months after discontinuation of amiodarone. High-dose beta-blocker therapy alone was insufficient to adequately control the ventricular arrhythmias and a complete clinical response required the introduction of high-dose corticosteroids and methimazole. Thyroid function tests normalised and both symptoms and arrhythmias improved during follow-up.