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Mohamed AA, Basaran T, Othman MH, Andersen NH, Bonnema SJ. The association between Takotsubo cardiomyopathy and thyrotoxicosis: A systematic review. Endocrine 2022; 78:418-428. [PMID: 36018537 DOI: 10.1007/s12020-022-03174-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 08/09/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE This study aims to review all published cases on the association between thyrotoxicosis and Takutsubo Syndrome by describing clinical characteristics, diagnostic work-up, treatment, and outcome. METHODS We searched PubMed and Embase databases from inception to the 17th of February 2022 for case reports or series reporting the above-mentioned association. We extracted data on demographic characteristics, clinical features, diagnostic work-up, treatment, and clinical outcomes. Cases were stratified into groups based on the presumed cause of the thyrotoxicosis (iatrogenic vs non-iatrogenic and Graves' diseases vs non-Graves' disease, respectively). RESULTS We identified 25 cases from 24 articles. The mean age was 61.7 years (+/- SD 14.5). Most patients were women (88%). Graves' disease (52%) was the leading cause of thyrotoxicosis. Previous cancer was significantly more common in patients with iatrogenic thyrotoxicosis (P = 0.03). The most common symptoms were respiratory symptoms (68%), chest pain (56%), and palpitations (40%). The most common ECG characteristics were T-wave abnormalities (48%) and ST-elevations (36%). Elevated troponin levels were found in 92% of the cases. Patients with Graves's disease and Takutsubo Syndrome had higher plasma levels of serum thyroxine (P = 0.03) and were more often treated with beta-blockers (P = 0.01) compared to patients with thyrotoxicosis of other origins. Notably, 40% of cases experienced in-hospital complications. No deaths were reported. All patients had improved cardiac function within a median follow-up of 42 days. CONCLUSION Evidence-based on current case reports suggests an increased risk of Takutsubo Syndrome and subsequently increased risk of in-hospital complications in patients with thyrotoxicosis.
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Affiliation(s)
| | - Tayfun Basaran
- Department of Cardiology, Herlev-Gentofte Hospital, Copenhagen, Denmark
| | | | | | - Steen Joop Bonnema
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
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Gupta S, Goyal P, Idrees S, Aggarwal S, Bajaj D, Mattana J. Association of Endocrine Conditions With Takotsubo Cardiomyopathy: A Comprehensive Review. J Am Heart Assoc 2018; 7:e009003. [PMID: 30371307 PMCID: PMC6404898 DOI: 10.1161/jaha.118.009003] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Sonali Gupta
- Department of MedicineSt. Vincent's Medical CenterBridgeportCT
- The Frank H. Netter MD School of Medicine at Quinnipiac UniversityNorth HavenCT
| | - Pradeep Goyal
- The Frank H. Netter MD School of Medicine at Quinnipiac UniversityNorth HavenCT
- Department of RadiologySt. Vincent's Medical CenterBridgeportCT
| | - Sana Idrees
- Department of MedicineSt. Vincent's Medical CenterBridgeportCT
- The Frank H. Netter MD School of Medicine at Quinnipiac UniversityNorth HavenCT
| | - Sourabh Aggarwal
- Cardiology DivisionDepartment of MedicineUniversity of Nebraska Medical CenterOmahaNE
| | - Divyansh Bajaj
- Department of MedicineSt. Vincent's Medical CenterBridgeportCT
- The Frank H. Netter MD School of Medicine at Quinnipiac UniversityNorth HavenCT
| | - Joseph Mattana
- Department of MedicineSt. Vincent's Medical CenterBridgeportCT
- The Frank H. Netter MD School of Medicine at Quinnipiac UniversityNorth HavenCT
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Sakuma I, Koide H, Yoshida T, Yamato A, Fujimoto M, Tamura A, Komai E, Kono T, Nagano H, Horiguchi K, Yokote K, Tanaka T. Congestive Heart Failure Secondary to a TSH-Secreting Pituitary Adenoma Aggravated by Takotsubo Cardiomyopathy in an Elderly Patient. AACE Clin Case Rep 2018. [DOI: 10.4158/ep171968.cr] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Murdoch D, O'Callaghan W, Reda E, Niranjan S. Takotsubo Cardiomyopathy Associated with Primary Hyperthyroidism Secondary to Toxic Multinodular Goiter. Int J Angiol 2015; 25:e121-e122. [PMID: 28031674 DOI: 10.1055/s-0035-1548548] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Takotsubo cardiomyopathy is increasingly recognized as a distinct clinical entity. An association with thyroid disease has been identified in several case reports, mostly in the context of Grave disease. We report the case of a 67-year-old woman presenting with takotsubo cardiomyopathy and thyrotoxicosis secondary to toxic multinodular goiter. Previously unreported, this suggests that this association is related to the direct effects of thyroid hormone, rather than an autoimmune mechanism. Thyroid disease should be considered in patients presenting with takotsubo cardiomyopathy.
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Affiliation(s)
- Dale Murdoch
- Department of Cardiology, The Prince Charles Hospital, Brisbane, Australia; School of Medicine, The University of Queensland, Brisbane, Australia
| | - William O'Callaghan
- Department of Endocrinology, Gold Coast University Hospital, Gold Coast, Australia
| | - Elham Reda
- Department of Endocrinology, Gold Coast University Hospital, Gold Coast, Australia
| | - Selvanayagam Niranjan
- Department of Endocrinology, Gold Coast University Hospital, Gold Coast, Australia; School of Medicine, Griffith University, Gold Coast, Australia
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De Giorgi A, Fabbian F, Tiseo R, Parisi C, Misurati E, Molino C, Pala M, Salmi R, Volpi R, Manfredini R. Takotsubo cardiomyopathy and endocrine disorders: a mini-review of case reports. Am J Emerg Med 2014; 32:1413-7. [PMID: 25261397 DOI: 10.1016/j.ajem.2014.07.030] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 07/17/2014] [Accepted: 07/26/2014] [Indexed: 01/20/2023] Open
Affiliation(s)
- Alfredo De Giorgi
- Clinica Medica, Department of Medicine, Azienda Ospedaliera-Universitaria (AOU), Ferrara, Italy.
| | - Fabio Fabbian
- Clinica Medica, Department of Medicine, AOU, Ferrara, Italy.
| | - Ruana Tiseo
- Clinica Medica, Department of Medicine, AOU, Ferrara, Italy.
| | - Claudia Parisi
- Clinica Medica, Department of Medicine, AOU, Ferrara, Italy.
| | - Elisa Misurati
- Clinica Medica, Department of Medicine, AOU, Ferrara, Italy.
| | | | - Marco Pala
- Clinica Medica, Department of Medicine, AOU, Ferrara, Italy.
| | - Raffaella Salmi
- Second Internal Medicine, Department of Medicine, AOU, Ferrara, Italy.
| | - Riccardo Volpi
- Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy.
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Eliades M, El-Maouche D, Choudhary C, Zinsmeister B, Burman KD. Takotsubo cardiomyopathy associated with thyrotoxicosis: a case report and review of the literature. Thyroid 2014; 24:383-9. [PMID: 23560557 PMCID: PMC3926154 DOI: 10.1089/thy.2012.0384] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Takotsubo or stress-induced cardiomyopathy is a form of reversible cardiomyopathy commonly associated with emotional or physical stress. Thyrotoxicosis has been identified as a rare cause of Takotsubo cardiomyopathy, with only 12 cases reported in the literature. Here, we report a case of thyroid storm presenting with Takotsubo cardiomyopathy in the setting of Graves' disease. PATIENT FINDINGS A 71-year-old woman presented with abdominal pain, vomiting, confusion, and history of weight loss. She was initially diagnosed and treated for diabetic ketoacidosis at another hospital and was transferred to our hospital one day after initial presentation because of concern for acute coronary syndrome. A diagnosis of Takotsubo cardiomyopathy was made on the basis of cardiac catheterization. At that time, she was diagnosed and treated for thyroid storm. Follow-up 7 weeks later revealed improvement of her cardiac function and near-normalization of thyroid hormone levels. SUMMARY In this patient, who presented with symptoms of heart failure, acute coronary syndrome was initially considered, but the diagnosis of Takotsubo cardiomyopathy associated with thyroid storm was ultimately made based on cardiac catheterization and laboratory investigation. CONCLUSIONS Thyrotoxicosis is associated with adverse disturbances in the cardiovascular system. Takotsubo cardiomyopathy could be a presenting manifestation of thyroid storm, perhaps related to excess catecholamine levels or sensitivity.
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Affiliation(s)
- Myrto Eliades
- Department of Internal Medicine, Medstar Washington Hospital Center, Washington, District of Columbia
| | - Diala El-Maouche
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Chitra Choudhary
- Department of Internal Medicine, Medstar Washington Hospital Center, Washington, District of Columbia
| | - Bruce Zinsmeister
- Department of Internal Medicine, Medstar Washington Hospital Center, Washington, District of Columbia
- Sections of Endocrinology and Cardiology, Medstar Washington Hospital Center, Washington, District of Columbia
| | - Kenneth D. Burman
- Department of Internal Medicine, Medstar Washington Hospital Center, Washington, District of Columbia
- Sections of Endocrinology and Cardiology, Medstar Washington Hospital Center, Washington, District of Columbia
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Takotsubo cardiomyopathy "variations on a theme". Case Rep Cardiol 2011; 2011:131828. [PMID: 24804107 PMCID: PMC4007749 DOI: 10.1155/2011/131828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2011] [Accepted: 07/03/2011] [Indexed: 11/30/2022] Open
Abstract
Takotsubo Cardiomyopathy (TTC) is a fairly new diagnosis in the cardiologist's repertoire. It can present itself in multiple different forms. We describe three cases of TTC with different etiologies illustrating the broad spectrum of presentations.
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Kahina B, Maiza JC, Bennet A, Caron P. Crise thyréotoxique : adjonction de la colestyramine au traitement conventionnel. Presse Med 2010; 39:1217-20. [DOI: 10.1016/j.lpm.2010.05.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2010] [Revised: 05/01/2010] [Accepted: 05/20/2010] [Indexed: 01/26/2023] Open
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Kwon SA, Yang JH, Kim MK, Park SW, Kim SH, Park KH, Park WJ. A case of Takotsubo cardiomyopathy in a patient with iatrogenic thyrotoxicosis. Int J Cardiol 2009; 145:e111-3. [PMID: 19628289 DOI: 10.1016/j.ijcard.2009.06.040] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2009] [Accepted: 06/18/2009] [Indexed: 01/01/2023]
Abstract
Takotsubo cardiomyopathy is a condition caused by intense emotional or physical stress leading to rapid and severe reversible cardiac dysfunction. The etiology and mechanism of this disease are unknown. Thyroid hormone has many effects on the heart and vascular system. There were some reports of Takotsubo cardiomyopathy with hyperthyroidism, especially Grave's disease. We report a patient who presented chest pain and cardiac arrest, and finally diagnosed as Takotsubo cardiomyopathy caused by iatrogenic thyrotoxicosis.
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Lentschener C, Vignaux O, Spaulding C, Bonnichon P, Legmann P, Ozier Y. Early postoperative tako-tsubo-like left ventricular dysfunction: transient left ventricular apical ballooning syndrome. Anesth Analg 2006; 103:580-2. [PMID: 16931664 DOI: 10.1213/01.ane.0000226091.19987.c6] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
We diagnosed transient left ventricular apical wall motion abnormalities after surgery in a patient presenting with a clinical and electrocardiographic picture of acute myocardial infarction in the absence of significant coronary disease. These angiographic, clinical, and electrocardiographic features satisfied the criteria of the recently described tako-tsubo-like left ventricular dysfunction.
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Affiliation(s)
- Claude Lentschener
- Department of Anesthesia and Critical Care, Université Paris-Descartes, Faculté de Médecine, Assistance Publique-Hôpitaux de Paris, Hôpital Cochin, Paris, France.
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