Hyperthyroidism Hyperthyroidism (overactive thyroid) is a condition in which the thyroid gland produces the high level of the hormone thyroxine. In other words, it can be called as overreactive thyroid. The thyroid gland is an organ located in the front of your neck and releases hormones that control your metabolism (the way your body uses energy), breathing, heart rate, nervous system, weight, body temperature, and many other functions in the body. When the thyroid gland is overactive (hyperthyroidism) the body’s processes speed up and you may experience nervousness, anxiety, rapid heartbeat, hand tremor, excessive sweating, weight loss, and sleep problems, among other symptoms. Pathophysiology In hyperthyroidism, serum T3 usually increases more than does T4, probably because of increased secretion of T3 as well as the conversion of T4 to T3 in peripheral tissues. In some patients, only T3 is elevated (T3 toxicosis). T3 toxicosis may occur in any of the usual disorders that cause hyperthyroidism, including Graves’ disease, multinodular goitre, and the autonomously functioning solitary thyroid nodule. If T3 toxicosis is untreated, the patient usually also develops laboratory abnormalities typical of hyperthyroidism (ie, elevated T4 and 123I uptake). The various forms of thyroiditis commonly have a hyperthyroid phase followed by a hypothyroid phase. Causes A variety of conditions can cause hyperthyroidism. Graves’ disease, an autoimmune disorder, is the most common cause of hyperthyroidism. It causes antibodies to stimulate the thyroid to secrete too much hormone. Other causes of hyperthyroidism include: Excess iodine, a key ingredient in T4 and T3 Thyroiditis, or inflammation of the thyroid, which causes T4 and T3 to leak out of the gland Tumours of the ovaries or testes Benign tumours of the thyroid or pituitary gland Large amounts of tetraiodothyronine taken through dietary supplements or medication Risk factors Have a family history of thyroid disease Have other health problems, including Pernicious anaemia, a condition caused by a vitamin B12 deficiency Type 1 diabetes Primary adrenal insufficiency, a hormonal disorder Eating large amounts of food containing iodine, such as kelp, or use medicines that contain iodine, such as amiodarone, a heart medicine Older than age 60, especially if you are a woman Pregnant within the past 6 months Clinical manifestations The symptoms of hyperthyroidism include the following: An enlarged thyroid gland (goitre), which may appear as a swelling at the base of your neck Fatigue or muscle weakness Light periods or skipping periods. Weight loss Hand tremors Mood swings Rapid heartbeat Nervousness or anxiety Trouble sleeping Protruded eyeballs Skin dryness fine, brittle hair Heart palpitations or irregular heartbeat Increased frequency of bowel movements Breast development in men Complications Heart problems include atrial fibrillation and congestive heart failure An irregular heartbeat that can lead to blood clots, stroke, Brittle bones like osteoporosis Graves’s ophthalmology may exhibit eye problems including bulging, red or swollen eyes, sensitivity to light, and blurring or double vision. Red, swollen skin. Thyrotoxic crisis. Diagnosis and Test Thyroid function blood test Thyroid function test is performed using a sample of blood obtained from the patient with hyperthyroidism. It is used to check the levels of: Thyroid-stimulating hormone (TSH) – a hormone produced by the pituitary gland (a gland at the base of the brain) that controls the production of thyroid hormones Triiodothyronine (T3) – one of the main thyroid hormones Thyroxine (T4) – another of the main thyroid hormones Your levels will be compared to what’s normal for a healthy person. A low level of TSH and high levels of T3 and/or T4 usually means you have an overactive thyroid. Radioactive Iodine Uptake Test To detect the way thyroid gland takes in and absorbs the orally given iodine dose and uses it to produce thyroid hormones. Conclusions are drawn based on the results obtained in this test. Thyroid scan A dye-injection or oral iodine dose test that enables visualization of the thyroid gland, which is seen on a computer. It helps to detect whether a region of the thyroid gland or the entire gland is affected. Ultrasound Scan – To detect the enlargement of the thyroid gland and surrounding structures. CT or MRI Scan – Scanning specified region if a tumour is suspected. Treatment and Medications No single treatment is best for all patients with hyperthyroidism. The appropriate choice of treatment will be influenced by your age, the type of hyperthyroidism that you have, the severity of your hyperthyroidism, other medical conditions that may be affecting your health, and your own preference. Antithyroid Drugs: Drugs known as antithyroid agents-methimazole (Tapazole®) or in rare instances propylthiouracil (PTU)-may be prescribed to treat the hyperthyroidism by blocking the thyroid glands to secrete thyroid hormones. Methimazole is preferred due to less severe side-effects. These drugs work well to control the overactive thyroid, and do not cause permanent damage to the thyroid gland. Radioactive Iodine: Another way to treat hyperthyroidism is to damage or destroy the thyroid cells that make thyroid hormone. Because these cells need iodine to make thyroid hormone, they will take up any form of iodine in your bloodstream, whether it is radioactive or not. The radioactive iodine used in this treatment is administered by mouth, usually in a small capsule that is taken just once. Once swallowed, the radioactive iodine gets into the bloodstream and rapidly it is taken up by the overactive thyroid cells. The radioactive iodine that is not taken up by the thyroid cells disappears from the body within days over a period of several weeks to several months (during which time drug treatment may be used to control hyperthyroid symptoms), radioactive iodine destroys the cells that have taken it up. The result is that the thyroid or thyroid nodules shrink in size, and the level of thyroid hormone in the blood returns to normal. Thyroid surgery: Hyperthyroidism can be permanently cured by surgical removal of all or most of the thyroid gland. This procedure is best performed by a surgeon who has experience in thyroid surgery. An operation could be risky unless the hyperthyroidism is first controlled by an anti-thyroid drug or a beta-blocking drug, usually for few days before surgery, a surgeon may prescribe to take drops of nonradioactive iodine-either Lugol’s iodine or supersaturated potassium iodide (SSKI). This extra iodine reduces the blood supply to the thyroid gland and thus makes the surgery easier and safer. Beta-Blockers: Beta blockers do not stop thyroid hormone production but can reduce symptoms until other treatments take effect. Beta blockers act quickly to relieve many of the symptoms of hyperthyroidism, such as tremors, rapid heartbeat, and nervousness. Most people feel better within hours of taking beta blockers. Propranolol (Inderal®) was the first of these drugs to be developed. Some physicians now prefer related, but longer-acting beta-blocking drugs such as atenolol (Tenormin®), metoprolol (Lopressor®), nadolol (Corgard®), and Inderal-LA® because of their more convenient once- or twice-a-day dosage. Prevention and Cure Patients being treated for hyperthyroidism need to follow-up with the physician for regular monitoring. For weight loss, fatigue and other complaints a proper nutritional plan is essential. To prevent further weakness, bone thinning and to maintain good health, it is necessary to follow a proper diet plan and healthy routine as advised by the physician. Taking calcium and vitamin D supplements may be considered with medical advice. Regular exercise can help to improve bone and heart health. For those suffering from eye disturbances or Grave’s ophthalmology, special care of the eyes can help. Some measures include wearing sunglasses, applying cool eye compresses, using lubricating eye drops and raising the head while sleeping to relieve pressure on the eyes.

.HEALTH BENEFITS OF ARNICA YOU have ever tried Homeopathic medicine, you would be aware of the term ‘Arnica’. The fact that it is used as an active ingredient in medicines is itself an indication of the various arnica benefits. In fact, we often come across shampoos, gels, tonics and tinctures bearing the name of arnica. Arnica is basically a perennial herb belonging to the sunflower (Asteraceae) family. It is native to the mountains of Europe and Siberia. Arnica plant grows to a height of 1 to 2 feet and bears yellow-orange flowers resembling daisies. It possesses bright green leaves, the upper leaves are toothed and slightly hairy while the lower leaves have rounded tips. The stalks are round, fleshy, and hairy. The yellow-orange flowers of this herb have medicinal value. Extracts from fresh and dried flower heads are used in Homeopathic preparations for the treatment of several health conditions. The flowers can also be used in their raw form. Today, arnica is extensively cultivated for medicinal purposes in several areas of Europe and North America. It has been used in medicine since the 1500s and is commercially available in the form of topical creams, ointments, pills, tinctures and even injections. Arnica oil is also available, which is used for topical treatments. Direct intake of arnica by mouth is associated with serious side effects but homeopathic medicines use it in a diluted form which is not considered harmful. There are several species of arnica of which Arnica Montana and A. Chamissonis are used in anti-inflammatory preparations. Both species look similar except that A. Chamissonis has somewhat smaller flowers. It can be extremely toxic even in very low doses. Arnica Montana, on the other hand, possesses medicinal properties and is mostly used in herbal products, particularly hair care products. This herb is known by several names such as Mountain Tobacco, Mountain Daisy and even Leopard’s bane and Wolf’s bane. Arnica Benefits For Skin Image: Shutterstock Arnica is an active ingredient in several skin care products. It can improve your skin health and help you get rid of skin problems too. The various benefits of arnica for skin are as follows. 1. Treatment Of Skin Infections And Eczema Arnica can be applied topically to get rid of skin problems. Arnica extracts are used as an ingredient in several lotions meant for the treatment of skin infections, eczema, itchiness and open wounds. They can even be applied on the vagina to treat vaginitis and vaginal irritation. 2. Treatment Of Frost Bites And Chilblains Arnica extracts are used in ointments meant for treating frost bites. Often, frost bites do not appear as open wounds. Application of arnica ointment on frost bitten areas of the body can significantly improve the condition. This herb can also be used in the treatment of chilblains. 3. Skin Nourishment Arnica Montana flowers contain sesquiterpene lactones, flavonoids, carbonic acid, coumarins and volatile oils, all of which are beneficial for your skin. A sesquiterpene lactone, called helenalin, is the main restorative compound in Arnica Montana, which along with flavonoid, helps soothe and renew the skin after exposure to stress. The antibacterial, antiseptic and anti-inflammatory properties of this herb help in preventing inflammatory skin disorders. They also accelerate the healing process by stimulating the formation of granular tissues. Arnica for skin care can effectively heal bruises, sunburns, minor burns and superficial phlebitis. 4. Treatment Of Stretch Marks Topically rubbing arnica extracts reduces the appearance of pregnancy-related stretch marks. All you need to do is gently apply arnica gel on your stomach at least four times a day. [ Read: Olive Oil For Stretch Marks ] Benefits Of Arnica For Hair The anti-inflammatory properties of arnica make it usable in hair care as well. Arnica extracts are often used in conditioners and shampoos. Some of its benefits for hair are as follows. 6. Arnica For Hair Loss Usage of arnica extract rejuvenates your scalp and stimulates the hair follicles, helping to strengthen your hair and preventing it from falling prematurely. Arnica is combined with other ingredients like calendula and jaborandi in homeopathic Arnica Montana shampoos to provide soft and manageable hair. 7. Treatment Of Dandruff Arnica cleanses the excess oil and sebum from the scalp, giving it a natural shine. By removing dirt, debris, and oil from the scalp, it also helps combat dandruff and itchiness. This also helps in preventing tangled and rough hair. 8. Treatment Of Split Ends And Premature Greying Of Hair Arnica is used at a concentration of 1% to 2% in hair care products. Being an antibiotic, it can effectively cure scalp infections. It strengthens each and every hair strand and helps prevent split ends and premature graying of hair. All you need to do is massage arnica hair oil on your scalp from the roots to the tips before going to bed and wash off the next morning. This will nourish your hair and prevent these problems by providing the requisite nutrition to your hair follicles. Health Benefits Of Arnica As stated earlier, arnica is used in the treatment of a wide range of internal and external disorders. Though arnica is not FDA approved like other herbal remedies, it does contain several active ingredients and volatile oils. Proper dosage of arnica will definitely provide the following health benefits: 9. Treatment Of Arthritis The anti-inflammatory properties of arnica are praiseworthy. It has been used in topical preparations for healing joint pains, muscle aches and swelling associated with arthritis. A research conducted in 2002 indicated that the use of arnica gel twice daily for 6 weeks resulted in a significant decrease in pain and stiffness in patients with mild to moderate osteoarthritis of the knee. In the case of osteoarthritis of the hand, arnica gel has proven to be as effective as ibuprofen in lessening pain and improving hand function. The essence of arnica plant is used in the treatment of rheumatoid arthritis. Being an anti-inflammatory agent, it can be used to massage inflamed or painful joints for relief. 10. Treatment Of Muscle Soreness The anti-inflammatory properties of this herb make it useful for the treatment of muscle soreness. It can be applied topically to reduce pain and inflammation caused by muscle sprain and strains. Thus, it is beneficial for athletes who often suffer from muscle soreness. 11. Healing Qualities Arnica has been used in topical preparations for healing bruises, muscle aches, superficial phlebitis, wounds and swelling due to insect bites and fractures. It can be used as a mouthwash or gargle for treating sore throat and infections. However, it should be used and consumed according to the directions of the physician. It helps in the regeneration of tissues and can heal injuries. It is also effective in healing burns. It improves blood circulation by stimulating white blood cell activity, decreasing the amount of healing time and reducing inflammation. 12. Treatment Of Post-Surgery Pain A study conducted in 2007 observed that taking a homeopathic dilution of arnica resulted in a decrease in pain in patients whose tonsils were removed. Similarly, taking a homeopathic dilution of arnica and topical application of arnica ointment reduces post-surgery pain in patients undergoing surgery for carpel tunnel syndrome. 13. Treatment Of Bruises And Black Eyes Arnica is effective in reducing the appearance of bruises. Topical application of arnica extract on bruises and black eyes can significantly improve the condition. Infusions from arnica plant are effective in the treatment of dark nails caused due to injuries from heavy objects. 14. Oral Health The anti-bacterial and anti-microbial properties of arnica make it great for oral health. Arnica mouthwashes are widely available and can treat bacterial infections in the mouth. Washing your mouth with arnica and water regularly can cure conditions like gingivitis and pyorrhoea. It can also reduce wisdom tooth pain. 15. Treatment Of Post Surgery Swelling A study conducted in 2006 has proved that intake of homeopathic dilution of arnica may slightly reduce post-operative swelling in patients undergoing arthroscopy. 16. Treatment Of Stress And Depression In addition to its medicinal uses, arnica is beneficial in alleviating feelings of depression and emotional distress. It is often used in healing sachets to restore emotional balance and a sense of tranquility. Organic and wild grafted arnica flower extract can be massaged to provide warmth which unwinds your taxed and tight muscles and alleviates stress. 17. Other Benefits Arnica has been used in homeopathy for the treatment of an accident or shock as well as illness of the circulatory system. It is also used in the treatment of conditions like a backache, fibromyalgia, influenza, headaches, migraines and hemorrhoids. Nutritional Value Of Arnica Arnica owes its anti-inflammatory properties to a host of active components comprising of antioxidants, tannins, flavonoids, carotenoids and volatile oils like thymol, an active ingredient contained in thyme. The in-depth nutritional profile of arnica can be understood from the table given below. NUTRITION FACTS CALORIES IN ARNICA MONTANA HOMEPATHIC Serving Size: 1 serving Amount Per Serving Calories 0.0 Total Fat 0.0 g Saturated Fat 0.0 g Polyunsaturated Fat 0.0 g Monounsaturated Fat 0.0 g Cholesterol 0.0 mg Sodium 0.0 mg Potassium 0.0 mg Total Carbohydrate 0.0 g Dietary Fiber 0.0 g Sugars 0.0 g Protein 0.0 g Vitamin A 0.0 % Vitamin B-12 0.0 % Vitamin B-6 0.0 % Vitamin C 0.0 % Vitamin D 0.0 % Vitamin E 0.0 % Calcium 0.0 % Copper 0.0 % Folate 0.0 % Iron 0.0 % Magnesium 0.0 % Manganese 0.0 % Niacin 0.0 % Pantothenic Acid 0.0 % Phosphorus 0.0 % Riboflavin 0.0 % Selenium 0.0 % Thiamin 0.0 % *Percent Daily Values are based on a 2,000 calorie diet. Your daily values may be higher or lower depending on your calorie needs. Precautions This herb which provides amazing benefits for your skin, hair, and health, is also associated with several side effects when used excessively. That is why it is important to exercise caution while using it in any form. 1. Stomach Discomfort Arnica can irritate the digestive system and its lining called mucosa. For this reason, arnica is never taken orally. Even taken in low dosage in homeopathy medicine, it causes irritation in the stomach. This irritation further leads to pain and loss of appetite. But, this problem is temporary and goes away within a day or two. 2. Breast Feeding And Pregnancy Arnica usage should be avoided if you are pregnant or breast feeding. Arnica is considered as unsafe for pregnant or breast feeding women. 3. Vomiting As mentioned before, arnica irritates the stomach when taken orally. This irritation may further cause severe nausea or an urge to vomit. This side effect is common among many individuals consuming arnica. 4. Allergy People sensitive to Compositae or Asteraceae family plants, which includes chrysanthemums, ragweed, marigolds, daisies and related plants, might also be allergic to arnica. People who are hypersensitive to such plants should consult the doctor before using arnica in any form. 5. Nose Bleeding Arnica can also cause nosebleeds, which is not considered as a serious effect by American Cancer Society. A bleeding nose is not a problem in itself. Rather, it indicates that there is an internal bleeding that needs to be treated. It is best to discontinue the use of arnica on encountering such side effect and immediately visit your doctor. 6. Dizziness Dizziness occurs as a side effect when arnica is taken for internal issues. When you experience such side effect, consult your doctor immediately. 7. Interactions With Drugs Arnica may interact with a number of corticosteroids, anesthetic, and anti-inflammatory drugs. It can also cause bleeding when taken with anticoagulants. Specific constituents present in arnica might lower serum lipids in the body. Those taking drugs for lowering cholesterol should take arnica with a caution. 8. Heart Problems American Cancer Society indicates that arnica might cause irregularities in heart rhythm. This is a condition where the heart beats irregularly. It might either slow down or speed up, causing palpitations. So, consult your doctor immediately if you experience severe palpitations. This is one of the dangerous side effects of arnica since it can cause death. It needs an immediate diagnosis. 9. Tremors American Cancer Society reports tremor as one of the most common side effects of taking arnica orally. The person might experience uncontrollable movements of legs and hands. Such side effect requires medical evaluation. Tremors signal that your central nervous system has been affected. 10. Other Side Effects Arnica in undiluted form is considered unsafe. According to a report, it causes faster heart beat, cardiac arrest, stomach pain, diarrhea, vomiting, skin rashes and shortness of breath. Its toxicity might also cause dyspnea and gastroenteritis. It might also cause damage to your heart, increase the blood pressure level, and organ failure. Sometimes, its consumption leads to coma and even death. Tips On Arnica Usage After knowing the amazing arnica benefits, its time to know how to use this wonderful herb. Before consuming arnica, it is important to dilute arnica. Taking arnica in undiluted form can lead to chronic side effects. Avoid application of arnica on broken skin. Homeopathic doses should also be used according to specific instructions. Arnica forms an integral part of homeopathy. It offers various benefits. But, if you play doctor and overlook the recommended dosage, you can experience any of these side effects. So, discuss completely arnica benefits and side effects with your doctor before the consumption to stay safe! So, the next time you use arnica in any of its forms, remembers the goodness you are getting and return!

A 3 month old male child presented to us with multiple episodes of seizures. There was a history of fever along with cough n cold. Patient had a history of obstructed labour n one day NICU stay. Reports are attached. Please provide ur precious views. I have added a photo of patient there some Neurocutaneous marker near left hypochondrium region.

AMIODARONE. Amiodarone is a complex anti arrhythmic agent with multiple electrophysiological effects,unusal pharmacokinetics,and numerous potentially harmful drug interactions and adverse effects. Although the USFDA has labelled amiodarone only for the treatment of life threatening ventricular arrhythmias, the drug is also used to treat atrial fibrillation. PHARMACOKINETICS. Amiodarone is an iodine containing compound with structural similarity to thyroxine.The drug's high iodine content likely is a factor in it's effects on the Thyroid gland. Amiodarone is highly lipid soluble and is stored in high concentrations in fat and muscle as well as in the lungs,liver and skin. Amiodarone crosses the placenta and reaches measurable levels in the breast milk. Grapefruit juice can inhibit amiodarone metabolism and lead to elevated drug levels. The elimination half life is unusually long 58 days. The long half-life is thought to be a result of the drug's slow release from lipid -rich tissues. ELECTROPHYSIOLOGICAL EFFECTS. *Amiodarone is considered to be a class III drug ( Vaughan Williams classification ), which indicates that IT PROLONGS THE QT INTERVAL. However,, the drug has many other effects. *It slows heart rate and atrioventricular nodal conduction (via calcium channel and beta receptor blockade ) *Prolongs refractoriness (via potassium and sodium channel blockade) *Slows intra cardiac conduction (via sodium channel blockade) INDICATIONS LONG TERM TREATMENT. Amiodarone is approved for use in the secondary prevention of life threatening ventricular arrhythmias. NORTH AMERICAN SOCIETY FOR PACING AND ELECTROPHYSIOLOGY (NASPE ) RECOMMENDS AMIODARONE AS THE ANTI ARRHYTHMIC AGENT OF CHOICE IN PATIENTS WHO HAVE SURVIVED SUSTAINED VENTRICULAR ARRHYTHMIAS,PARTICULARLY THOSE WITH LEFT VENTRICULAR DYSFUNCTION. Amiodarone is used in the treatment of atrial fibrillation,although the FDA has not approved this indication. ACUTE TREATMENT. INTRAVENOUSLY ADMINISTERED AMIODARONE IS EFFECTIVE FOR THE EMERGENCY TREATMENT OF VENTRICULAR TACHYARRHYTHMIAS. Onset of anti arrhythmic effect of amiodarone occurs in less than 30 minutes. Intravenously administered amiodarone is being used with increasing frequency in the treatment of ATRIAL FIBRILLATION. ADVERSE EFFECTS. Toxicity of amiodarone involves Lungs, Liver, Eyes, Thyroid, Skin and Nerves. The frequency of adverse effects is related to the dosage and duration of the treatment. Therefore,physicians must use the lowest possible dosage of amiodarone and discontinue treatment if adverse effects occur. PULMONARY TOXICITY. The most serious potential adverse effect of amiodarone therapy is pulmonary toxicity,which may result from direct drug induced phospholipidosis or immune-mediated hypersensitivity. The most common clinical presentation is subacute cough and progressive dyspnea. CXR shows patchy interstitial infiltrates. Pulmonary function tests show reduced diffusing capacity. The primary treatment of pulmonary toxicity is withdrawal of amiodarone and provision of supportive care.corticosteroids are used in some cases.In most instances,toxicity is reversible. THYROID TOXICITY. Thyroid toxicity is the most common complication that requires intervention. Amiodarone therapy can cause Hypothyroidism or hyperthyroidism. In hypothyroid patients with a strong clinical indication for amiodarone, the drug may be continued with appropriate Thyroid hormone supplementation. Treatment of amiodarone induced hyperthyroidism needs withdrawal of amiodarone. LIVER TOXICITY. Liver toxicity is manifested by elevation of liver transaminase levels. IF THE ENZYMES ARE THREE TIMES HIGHER THAN NORMAL,AMIODARONE SHOULD BE DISCONTINUED UNLESS A PATIENT IS AT HIGH RISK FOR RECURRENCE OF LIFE THREATENING ARRHYTHMIAS. GASTROINTESTINAL ADVERSE EFFECTS Nausea,anorexia and constipation. OCULAR ADVERSE EFFECTS Corneal microdeposits are visible on the slit lamp examination in nearly all patients on amiodarone In some cases,optic neuropathy progresses to total blindness. ANY PERSON WHO NOTES CHANGES IN VISUAL ACUITY OR PERIPHERAL VISION SHOULD BE REFERRED FOR OPHTHALMOLOGICAL EVALUATION. DERMATOLOGICAL ADVERSE EFFECTS Photosensitivity is common in patients receiving amiodarone. BLUE - GRAY PIGMENTATION MAY DEVELOP IN EXPOSED AREAS. The discoloration resolves over a period of several months after amiodarone is discontinued. NEUROLOGICAL TOXICITY. Ataxia,parasthesia and tremor.peripheral neuropathy is reported. CARDIOVASCULAR ADVERSE EFFECTS Bradycardia and heart block occur in 1 -3 %of patients receiving amiodarone. AMIODARONE IS CONTRA INDICATED IN PATIENTS WITH SECOND OR THIRD DEGREE HEART BLOCK WHO DO NOT HAVE A PACEMAKER INTRAVENOUS AMIODARONE THERAPY SHOULD NOT BE USED IN PATIENTS WITH BRADYCARDIA OR HEART BLOCK WHO DO NOT HAVE A PACEMAKER. DRUG INTERACTIONS. Amiodarone is a potent inhibitor of hepatic and renal metabolism of several drugs. INTERACTIONS WITH WARFARIN AND DIGOXIN ARE MOST IMPORTANT CLINICALLY. IN A NUTSHELL. *ANTI ARRHYTHMIC AGENT *USED FOR TREATMENT OF LIFE THREATENING VENTRICULAR ARRHYTHMIAS *ALSO USED TO TREAT ATRIAL FIBRILLATION *IT IS AN IODINE CONTAINING COMPOUND *ABSORPTION OF DRUG IS ENHANCED WHEN TAKEN WITH FOOD *LONG HALF LIFE 58 DAYS *CLASS III DRUG *ADVERSE EFFECTS IN LUNG,LIVER,THYROID,SKIN,EYES CARDIOVASCULAR AND NEUROLOGICAL EFFECTS. *INTERACTIONS WITH WARFARIN AND DIGOXIN ARE MOST IMPORTANT CLINICALLY.

A 29-year-old female with a history of thyrotoxicosis which has been treated successfully with antithyroid medication had a relapse of thyrotoxicosis in the third trimester of pregnancy. She was treated with carbimazole for a short period but was intolerant of this and was therefore discontinued. She is now four weeks post partum and continues to experience tremor, sweats, palpitations, weight loss and flushing. She is also keen to breast feed and has been breast feeding her healthy infant boy. On examination she has fine tremor of the outstretched hands, a pulse rate of 110/min-1 and lid lag. She has a palpable goitre with an audible bruit. Otherwise she is haemodynamically stable, but eye examination reveals that she has exophthalmos, chemosis and lid-lag. Her investigations reveal: Treatment?