Myocardial infarction in Graves' disease without coronary artery disease

Focus on Autoimmune Myocarditis in Graves' Disease: A Case-Based Review

The manifestations of hyperthyroidism-related myocardial damage are multitudinous, including arrhythmia, dilated cardiomyopathy, valvular diseases, and even cardiogenic shock. Acute myocarditis induced by thyrotoxicosis had been reported in a few studies. However, attention on its prevalence and underlying mechanisms is sorely lacking. Its long-term harm is often ignored, and it may eventually develop into dilated cardiomyopathy and heart failure. We report a case of Graves' disease with a progressive elevation of hypersensitive cardiac troponin-I at several days after discontinuation of the patient's anti-thyroid drugs. Cardiac magnetic resonance imaging (CMRI) showed inflammatory edema of some cardiomyocytes (stranded enhanced signals under T2 mapping), myocardial necrosis (scattered enhanced signals under T1 late gadolinium enhancement) in the medial and inferior epicardial wall, with a decreased left ventricular systolic function (48%), which implied a possibility of acute myocarditis induced by thyrotoxicosis. The patient was then given a transient glucocorticoid (GC) treatment and achieved a good curative effect. Inspired by this case, we aim to systematically elaborate the pathogenesis, diagnosis, and treatment of hyperthyroidism-induced autoimmune myocarditis. Additionally, we emphasize the importance of CMRI and GC therapy in the diagnosis and treatment of hyperthyroidism-related myocarditis.

Sudden unexpected death in the setting of undiagnosed Graves' disease

Graves' disease is the most common cause of hyperthyroidism and is classically characterized by the clinical triad of diffuse toxic goiter, infiltrative ophthalmopathy with exophthalmos and an infiltrative dermopathy. While the name of the Irishman Robert Graves has received the eponymous honor, the first description of the condition in the English language can be attributed to the Englishman Caleb Perry, while in continental Europe the entity in name once honored Karl von Basedow. We present the case of a previously well 43 year old woman who presented in supraventricular tachycardia and acute pulmonary edema and died despite treatment and without a diagnosis for cause of death. At autopsy the significant positive macroscopic findings were confined to the lungs (acute pulmonary edema) and thyroid (diffusely enlarged). Histology revealed features typical of Graves' disease while post mortem thyroid function tests supported a diagnosis of thyrotoxic crisis in the setting of undiagnosed Graves' disease.

Takotsubo cardiomyopathy in a patient with multiple autoimmune disorders and hyperthyroidism

Takotsubo cardiomypathy is a very rare cardiovascular syndrome leading to myocardial infarction and left ventricular dysfunction in the absence of a detectable coronary artery lesion. It is accepted as reversible left ventricular asynergy occuring typically after an intrinsic adrenergic hyperstimulation. In this report we present Takotsubo cardiomyopathy in a 75-year-old patient with multiple autoimmune disorders.

Reversible left ventricular dysfunction "takotsubo" cardiomyopathy associated with hyperthyroidism

Myocardial stunning with hyperthyroidism is rare. A 79-year old woman with hyperthyroidism was admitted to our hospital complaining of palpitations due to paroxysmal atrial fibrillation. An echocardiogram showed akinesis of the apical wall which was not observed 2 weeks before admission. Cardiac catheterization performed in the acute phase showed normal coronary arteries and no evidence of provocative spasms. The wall motion abnormality disappeared entirely after 1 week in hospital. We report a case of transient left ventricular dysfunction, so called "takotsubo" cardiomyopathy, associated with hyperthyroidism.

Sudden death associated with undiagnosed Graves' disease

Hyperthyroidism may result in multiple symptoms attributable to an excess of thyroid hormone. We report a case of Graves' disease in association with sudden death in a previously healthy, undiagnosed young female. This case illustrates an unusual initial presentation of Graves' disease.