Thyrotoxic Atrial Fibrillation

Malvinder S. Parmar, MD, FRCPC, FACP

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In This Article

The Case Revisited

In the emergency department, after initial assessment and securing an intravenous line, we requested cardiac enzymes, an electrocardiogram, and a chest radiograph. Under cardiac monitoring, we gave metoprolol 5 mg intravenously every 5 minutes for 3 doses, followed by oral metoprolol 50 mg twice a day. We also started the patient on intravenous heparin and initiated antithyroid drug therapy with propylthiouracil 200 mg 3 times a day and Lugol's iodine 10 drops 3 times a day after starting propylthiouracil. We admitted the patient to the critical care unit. The patient reverted to sinus rhythm after 72 hours of starting antithyroid therapy and was discharged home the next day on antithyroid drug therapy, and oral anticoagulation therapy was continued for 6 weeks and then discontinued, as the patient remained in sinus rhythm. She elected to continue with antithyroid drug therapy.

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