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Fotso Simo SC, Lin KS, Bukharovich I. Thyrotoxic Cardiomyopathy: A Rare Case of Thyroid Storm Presenting as De Novo Heart Failure. Cureus 2024; 16:e57924. [PMID: 38725773 PMCID: PMC11079851 DOI: 10.7759/cureus.57924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2024] [Indexed: 05/12/2024] Open
Abstract
Thyroid storm and heart failure represent formidable challenges in clinical practice. Their coexistence, however, poses an even greater threat to the patient's well-being. To facilitate early recognition and appropriate management, an understanding of the complex interplay between these two conditions is crucial. Through comprehensive assessment, vigilant monitoring, and prompt intervention, outcomes can be improved and the morbidity and mortality mitigated. We present a rare case of a 40-year-old male who presented with severe de novo heart failure and a concurrent thyroid storm. Despite an initial left ventricular systolic ejection fraction of 20% and evidence of global dilatation and hypokinesis on echocardiography, appropriate management resulted in improved clinical status and ultimately recovery of cardiac function.
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Affiliation(s)
| | - Kai Shiang Lin
- Internal Medicine, State University of New York Downstate Medical Center, Brooklyn, USA
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2
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Karan A, Chekka P, Musa T, Esmail K. Graves' Disease-Associated Dilated Cardiomyopathy Unmasked by Blunt Chest Trauma. Cureus 2023; 15:e35488. [PMID: 36999098 PMCID: PMC10046486 DOI: 10.7759/cureus.35488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 02/26/2023] [Indexed: 02/27/2023] Open
Abstract
Graves' disease can manifest with numerous cardiovascular complications, although very few cases result in cardiomyopathy. Our patient presented following a motor vehicle accident where she suffered blunt chest trauma. Her initial presentation was concerning for acute heart failure due to blunt cardiac injury, with diffuse pulmonary edema, hemodynamic instability, and an acutely reduced ejection fraction with global hypokinesis on transthoracic echocardiography. On further evaluation with thyroid function testing and autoimmune studies, she was found to have uncontrolled Graves' disease. She was subsequently started on methimazole for her Graves' cardiomyopathy. Following discharge, an outpatient cardiac MRI revealed no late gadolinium enhancement and complete recovery of her ejection fraction to normal values. This case serves to highlight the importance of a complete evaluation of cardiomyopathy and highlights an interesting case of a patient with blunt chest injury with a background of undetected Graves' cardiomyopathy.
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Muacevic A, Adler JR, Woods L. Thyrotoxicosis-Induced Cardiomyopathy With Systolic Dysfunction. Cureus 2023; 15:e33988. [PMID: 36694856 PMCID: PMC9858885 DOI: 10.7759/cureus.33988] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2023] [Indexed: 01/21/2023] Open
Abstract
Thyrotoxicosis-induced dilated cardiomyopathy is a rare but potentially life-threatening complication of thyrotoxicosis, with an incidence of <1%. This condition is characterized by a dilatation of the ventricular chamber and a decrease in cardiac contractility. Untreated, it can lead to irreversible changes in cardiac structure and function, including dilated ventricular chamber, a decrease in ejection fraction (EF), and an increased risk of atrial fibrillation. We present a case of a 39-year-old patient with a diagnosis of thyrotoxicosis-induced acute heart failure. A two-dimensional (2D) echocardiogram disclosed an ejection fraction of 36%, with diffuse mild dilation of the atria and ventricles with trace mitral and tricuspid regurgitation. The anti-thyroid-stimulating hormone (TSH) receptor was positive, and Grave's disease was diagnosed. The patient eventually returned to baseline functional status and could return to basic activities of daily living without limitations. The patient was encouraged to follow up with outpatient cardiology. Early diagnosis of cardiac involvement in patients with thyrotoxicosis is critical. Promptly delivered intensive treatment with the rapid achievement of euthyroid state can potentially reverse cardiac dysfunction and improve patient outcomes.
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Mattesi G, Di Michele S, Mele D, Rigato I, Bariani R, Fiorencis A, Previtero M, Al Sergani A, Leoni L, Bauce B, Pergola V. Thyroid dysfunction on the heart: clinical effects, prognostic impact and management strategies. Monaldi Arch Chest Dis 2022; 92. [PMID: 35347972 DOI: 10.4081/monaldi.2022.2145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 03/08/2022] [Indexed: 11/22/2022] Open
Abstract
Thyroid hormones have a considerable influence on cardiac function and structure. There are direct and indirect effects of thyroid hormone on the cardiovascular system, which are prominent in both hypothyroidism and hyperthyroidism. In this review, we discuss how thyroid dysfunction impacts cardiovascular pathophysiology and the underlying molecular mechanisms.
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Affiliation(s)
- Giulia Mattesi
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua Medical School, Padua.
| | | | - Donato Mele
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua Medical School, Padua.
| | - Ilaria Rigato
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua Medical School, Padua.
| | - Riccardo Bariani
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua Medical School, Padua.
| | - Andrea Fiorencis
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua Medical School, Padua.
| | - Marco Previtero
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua Medical School, Padua.
| | - Abdullah Al Sergani
- King Faisal Specialist Hospital & Research Centre, The Heart Centre, Riyadh.
| | - Loira Leoni
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua Medical School, Padua.
| | - Barbara Bauce
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua Medical School, Padua.
| | - Valeria Pergola
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua Medical School, Padua.
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Moisa SM, Miron IC, Tarca E, Trandafir L, Lupu VV, Lupu A, Rusu TE. Non-Cardiac Cause of Death in Selected Group Children with Cardiac Pathology: A Retrospective Single Institute Study. CHILDREN 2022; 9:children9030335. [PMID: 35327707 PMCID: PMC8946943 DOI: 10.3390/children9030335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 02/24/2022] [Accepted: 02/26/2022] [Indexed: 12/05/2022]
Abstract
Background: Pediatricians and pediatric surgeons often face children with cardiomegaly and dilatative or hypertrophic cardiomyopathies presenting with or without symptoms. Some of these patients have already been diagnosed and received medication, and some present with completely unrelated pathologies. Methods: We performed a 4-year retrospective study on the causes and mechanisms of death of children with cardiac pathology who died outside the cardiology clinic of our hospital by studying the hospital charts and necropsy reports. All children who were in this situation in our hospital were included. Results: Most children in our study group were infants (81.82%), most were boys (81.82%), and in most cases, the cause or mechanism of death was unrelated to their heart condition, whether it had already been diagnosed or not (one case probably died as a result of a malignant ventricular arrhythmia). Additionally, 27.27% of children died as a consequence of bronchopneumonia, the same percentage died as a consequence of an acquired non-pulmonary disease or after surgery, and 18.18% died as a consequence of congenital malformations. Conclusions: Cardiac disease needs to be thoroughly investigated using multiple tools for all children presenting with heart failure symptoms, those with heart murmurs, and children scheduled for surgery of any type. The intensive care specialist and surgeon need to be aware of any heart pathology before non-cardiac surgical interventions.
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Affiliation(s)
- Stefana Maria Moisa
- Pediatrics Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (S.M.M.); (I.C.M.); (E.T.); (L.T.)
| | - Ingrith Crenguta Miron
- Pediatrics Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (S.M.M.); (I.C.M.); (E.T.); (L.T.)
| | - Elena Tarca
- Pediatrics Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (S.M.M.); (I.C.M.); (E.T.); (L.T.)
| | - Laura Trandafir
- Pediatrics Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (S.M.M.); (I.C.M.); (E.T.); (L.T.)
| | - Vasile Valeriu Lupu
- Pediatrics Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (S.M.M.); (I.C.M.); (E.T.); (L.T.)
- Correspondence: (V.V.L.); (A.L.)
| | - Ancuta Lupu
- Pediatrics Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (S.M.M.); (I.C.M.); (E.T.); (L.T.)
- Correspondence: (V.V.L.); (A.L.)
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Abstract
CONTEXT Thyroid storm can present as a multitude of symptoms, the most significant being cardiovascular (CV). It is associated with various manifestations such as cardiac arrhythmia, heart failure, and ischemia. However, the frequencies of events and characteristics associated with patients that experience these events are not known. METHODS Study cohort was derived from the National Inpatient Sample database from January 2012 to September 2015. Total hospitalizations of thyroid storm were identified using appropriate ICD-9 diagnostic codes. The analysis was performed using SAS. OBJECTIVE To better understand the frequency and characteristics CV occurrences associated with thyroid storm, through a retrospective analysis of thyroid storm hospital admissions. DESIGN The study cohort was derived from the National Inpatient Sample database from January 2012 to September 2015. SETTING Total hospitalizations of thyroid storm were identified using International Classification of Diseases (ICD)-9 diagnostic codes. The analysis was performed using Statistical Analysis System (SAS). RESULTS A total of 6380 adult hospitalizations were included in the final analysis, which includes 3895 hospitalizations with CV events (CEs). Most frequently associated CEs were arrhythmia (N = 3770) followed by acute heart failure (N = 555) and ischemic events (N = 150). Inpatient mortality was significantly higher in patients with CEs compared with those without CEs (3.5% vs 0.2%, P < 0.005). The median length of stay was also higher in patients with CEs compared with those without CEs (4 days vs 3 days, P < 0.0005). Atrial fibrillation was the most common arrhythmia type, followed by nonspecified tachycardia. CONCLUSIONS In patients who were hospitalized due to thyroid storm and associated CEs significantly increased in-hospital mortality, length of stay, and cost. Patients with obesity, alcohol abuse, chronic liver disease, and COPD were more likely to have CEs. Patients with CV complications were at higher risk for mortality. In-hospital mortality increased with ischemic events and acute heart failure. Further evaluation is needed to further classify the type of arrhythmias and associated mortality.
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Affiliation(s)
- Zainulabedin Waqar
- Department of Internal Medicine, Mercy St. Vincent Medical Center, Toledo, OH 43608, USA
| | - Sindhu Avula
- Department of Cardiology, Mercy St Vincent Medical Center, Toledo, OH 43608, USA
| | - Jay Shah
- Department of Internal Medicine, Mercy St. Vincent Medical Center, Toledo, OH 43608, USA
- Department of Cardiology, Mercy St Vincent Medical Center, Toledo, OH 43608, USA
| | - Syed Sohail Ali
- Department of Cardiology, Mercy St Vincent Medical Center, Toledo, OH 43608, USA
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Khatiwada S, Boro H, Farooqui FA, Alam S. Endocrine causes of heart failure: A clinical primer for cardiologists. Indian Heart J 2020; 73:14-21. [PMID: 33714404 PMCID: PMC7961238 DOI: 10.1016/j.ihj.2020.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 07/30/2020] [Accepted: 11/03/2020] [Indexed: 12/30/2022] Open
Abstract
Heart failure (HF) may be a presenting manifestation of a few endocrine disorders and should be considered in evaluation of heart failure causes. This clinically oriented review is an attempt to highlight the protean manifestations of heart failure in endocrine diseases which could present either as acute or chronic heart failure. Acute heart failure manifests as hypertensive crisis, Takotsubo syndrome, or as tachy/brady cardiomyopathies. Chronic heart failure could masquerade with features of hyperdynamic heart failure, or hypertrophic, restrictive or dilated cardiomyopathy. Rarely constrictive features or resistant heart failure could be the presenting feature. Isolated presentation as pulmonary hypertension and right heart failure are also documented. Good history-taking and physical examination with targeted investigations will help in the timely management for reversing the pathophysiology to a significant extent by appropriated management.
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Affiliation(s)
- Saurav Khatiwada
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - Hiya Boro
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India.
| | - Faraz Ahmed Farooqui
- Department of Cardiology, Holy Heart Advanced Cardiac Care and Research Centre, Rohtak, 124001, Haryana, India
| | - Sarah Alam
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
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Parolin M, Dassie F, Carlo ED, Vettor R, Maffei P. Dome-and-dart T Waves and Hyperthyroidism - A Case Report. EUROPEAN ENDOCRINOLOGY 2020; 16:69-71. [PMID: 32595773 DOI: 10.17925/ee.2020.16.1.69] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 11/29/2019] [Indexed: 11/24/2022]
Abstract
We briefly describe a case of a 31-year-old man with persistent hyperthyroidism, despite medical treatment with high dose methimazole. Twelve-lead 24-hour Holter monitoring showed bifid (or dome-and-dart) T waves and echocardiography revealed mild left ventricle dilatation. Hyperthyroidism was eventually treated with total thyroidectomy, and thereafter, T waves became normal and the left ventricle returned to normal dimensions. Hyperthyroidism should be considered among the differential diagnoses when T wave abnormalities are observed on electrocardiogram and when mild left ventricle dilatation is observed on an echocardiogram. The correction of hyperthyroidism can reverse these abnormalities.
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Affiliation(s)
- Matteo Parolin
- Department of Medicine, Internal Medicine-3, University of Padova, Padova, Italy
| | - Francesca Dassie
- Department of Medicine, Internal Medicine-3, University of Padova, Padova, Italy
| | - Eugenio De Carlo
- Department of Medicine, Internal Medicine-3, University of Padova, Padova, Italy
| | - Roberto Vettor
- Department of Medicine, Internal Medicine-3, University of Padova, Padova, Italy
| | - Pietro Maffei
- Department of Medicine, Internal Medicine-3, University of Padova, Padova, Italy
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Zhou M, Tan J, Liu J, Yin LX, Wang SJ, Xie L, Guo ZY, Zhang WJ. Changes in left ventricular function and contractile homogeneity in young adults with newly diagnosed hyperthyroidism due to Graves' disease. JOURNAL OF CLINICAL ULTRASOUND : JCU 2020; 48:216-221. [PMID: 31833078 DOI: 10.1002/jcu.22802] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 10/20/2019] [Accepted: 12/01/2019] [Indexed: 06/10/2023]
Abstract
PURPOSE The aim of this study was to investigate myocardial dysfunction and mechanical abnormalities in young patients with Graves' disease before therapy, using two-dimensional speckle tracking echocardiography. METHODS We performed a comprehensive transthoracic echocardiographic examination, including segmental and global radial strain, and time-to-peak radial strain, in 47 young patients with hyperthyroidism and 34 healthy adults. The time-to-peak radial strain was corrected by RR interval. The variables derived from radial myocardial deformation by the six-basal, six-mid, and six-apical segmental model were compared to investigate the difference of the myocardial function between the two groups. RESULTS Early diastolic mitral inflow velocity, E/A ratio, early diastolic mitral annular velocity, and e'/a' ratio were lower in patients with Graves' disease than in controls. The left ventricular end-diastolic volume, left ventricular end-systolic volume, stroke volume, cardiac output, heart rate, late diastolic mitral inflow velocity, and late diastolic mitral annular velocity were slightly higher in patients than in controls. Radial strain, global radial strain, and corrected time-to-peak radial strain were lower in the patient group. CONCLUSIONS The decreased radial strain, global radial strain, and corrected time-to-peak radial strain in young patients with newly diagnosed hyperthyroidism due to Graves' disease could serve as an early sign of subclinical cardiac involvement.
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Affiliation(s)
- Mi Zhou
- Department of Ultrasound in Medicine, Sichuan Provincial People's Hospital Affiliate Wenjiang Hospital, Chengdu, Sichuan, China
| | - Jing Tan
- Department of Ultrasound in Medicine, Sichuan Provincial People's Hospital Affiliate Wenjiang Hospital, Chengdu, Sichuan, China
| | - Jun Liu
- Department of Cardiovascular Ultrasound and Non-invasive Cardiology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, Sichuan, China
| | - Li-Xue Yin
- Department of Cardiovascular Ultrasound and Non-invasive Cardiology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, Sichuan, China
| | - Si-Jia Wang
- Department of Cardiovascular Ultrasound and Non-invasive Cardiology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, Sichuan, China
| | - Ling Xie
- Department of Ultrasound in Medicine, Meishan Second People's Hospital, Chengdu, Sichuan, China
| | - Zhi-Yu Guo
- GE Healthcare Cardiac and Vascular Ultrasound Clinic Education Team, Chengdu, Sichuan, China
| | - Wen-Jun Zhang
- Department of Ultrasound in Medicine, Sichuan Provincial People's Hospital Affiliate Wenjiang Hospital, Chengdu, Sichuan, China
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Khan R, Sikanderkhel S, Gui J, Adeniyi AR, O'Dell K, Erickson M, Malpartida J, Mufti Z, Khan T, Mufti H, Al-Adwan SA, Alvarez D, Davis J, Pendley J, Patel D. Thyroid and Cardiovascular Disease: A Focused Review on the Impact of Hyperthyroidism in Heart Failure. Cardiol Res 2020; 11:68-75. [PMID: 32256913 PMCID: PMC7092768 DOI: 10.14740/cr1034] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 02/21/2020] [Indexed: 12/12/2022] Open
Abstract
The association between thyroid hormones and cardiovascular conditions has been well studied, specifically, the effects of hypothyroidism on cardiomyopathy, and hyperthyroidism with arrhythmias. Nonetheless, an explicit correlation between hyperthyroidism and cardiomyopathy has yet to be established. Medical databases MEDLINE and PubMed were accessed and queried as primary sources for data acquisition. Search criteria consisted of “hyperthyroidism”, “heart failure”, and “thyroid and cardiovascular system”, which allowed the retrieval of relevant and recent works. From these sources, a consensus was developed and employed to yield an updated review of the etiology of heart failure in the setting of hyperthyroidism. It is rare for patients with hyperthyroidism to remain in a chronic hyperthyroid state, making it difficult to analyze subsequent long-term effects on the cardiovascular system. Related to heart failure, some studies have demonstrated no change in ejection fraction, while others have shown an acute change along with diastolic dysfunction, with or without an underlying rhythm abnormality. Further investigation is warranted to elucidate the mechanism driving such cardiac dysfunction, and whether it is due to vascular changes, tachyarrhythmias, or myocyte remodeling and fibrosis. The intent of this review article is to improve our understanding of how a hyperthyroid state affects cardiovascular function. An enhanced understanding of the effects on cardiovascular physiology will afford physicians the ability to provide more comprehensive care in consideration of both endocrine and cardiovascular pathologies.
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Affiliation(s)
- Rafay Khan
- Department of Cardiology, University of Tennessee at Chattanooga, 975 E 3rd Street, Chattanooga, TN 37403, USA
| | - Saad Sikanderkhel
- Department of Cardiology, University of Tennessee at Chattanooga, 975 E 3rd Street, Chattanooga, TN 37403, USA
| | - Junhong Gui
- Department of Cardiology, University of Tennessee at Chattanooga, 975 E 3rd Street, Chattanooga, TN 37403, USA
| | - Abdul-Razaq Adeniyi
- Department of Cardiology, University of Tennessee at Chattanooga, 975 E 3rd Street, Chattanooga, TN 37403, USA
| | - Kimberly O'Dell
- Department of Cardiology, University of Tennessee at Chattanooga, 975 E 3rd Street, Chattanooga, TN 37403, USA
| | - Marc Erickson
- Department of Cardiology, University of Tennessee at Chattanooga, 975 E 3rd Street, Chattanooga, TN 37403, USA
| | - Juan Malpartida
- Department of Cardiology, University of Tennessee at Chattanooga, 975 E 3rd Street, Chattanooga, TN 37403, USA
| | - Zarmina Mufti
- Frontier Medical College, Karakoram Highway, Mansehra Rd, Abbottabad, Khyber Pakhtunkhwa, Pakistan
| | - Taiba Khan
- Bucknell University, 701 Moore Ave, Lewisburg, PA 17837, USA
| | - Harris Mufti
- Frontier Medical College, Karakoram Highway, Mansehra Rd, Abbottabad, Khyber Pakhtunkhwa, Pakistan
| | - Saif Aldeen Al-Adwan
- Department of Cardiology, University of Tennessee at Chattanooga, 975 E 3rd Street, Chattanooga, TN 37403, USA
| | - Diana Alvarez
- Department of Cardiology, University of Tennessee at Chattanooga, 975 E 3rd Street, Chattanooga, TN 37403, USA
| | - Joshua Davis
- Department of Cardiology, University of Tennessee at Chattanooga, 975 E 3rd Street, Chattanooga, TN 37403, USA
| | - Joseph Pendley
- Department of Cardiology, University of Tennessee at Chattanooga, 975 E 3rd Street, Chattanooga, TN 37403, USA
| | - Dharmendra Patel
- Department of Cardiology, University of Tennessee at Chattanooga, 975 E 3rd Street, Chattanooga, TN 37403, USA
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Witczak JK, Ubaysekara N, Ravindran R, Rice S, Yousef Z, Premawardhana LD. Significant cardiac disease complicating Graves' disease in previously healthy young adults. Endocrinol Diabetes Metab Case Rep 2020; 2020:EDM190132. [PMID: 31967967 PMCID: PMC6993248 DOI: 10.1530/edm-19-0132] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 12/19/2019] [Indexed: 12/25/2022] Open
Abstract
SUMMARY Graves' disease is associated with tachydysrythmia, cardiac ischaemia and cardiomyopathy - all uncommon in young adults without previous cardiac disease. We present three young individuals who developed cardiac complications after periods of uncontrolled Graves' disease. Subject 1: A 34-year-old female had severe thyrotoxic symptoms for weeks. Investigations showed fT4: 98.4 (11-25 pmol/L), fT3: 46.9 (3.1-6.8 pmol/L), TSH <0.01 (0.27-4.2 mU/L) and thyrotrophin receptor antibody (TRAb): 34.8 (<0.9 U//l). She had appropriate treatment but several weeks later she became breathless despite improving thyroid function. Echocardiography showed a pericardial effusion of 2.9 cm. She responded well to steroids and NSAIDs but developed active severe Graves' orbitopathy after early total thyroidectomy. Subject 2: A 28-year-old male developed thyrotoxic symptoms (fT4: 38 pmol/L, fT3: 13.9 pmol/L, TSH <0.01 (for over 6 months) and TRAb: 9.3 U/L). One month after starting carbimazole, he developed acute heart failure (HF) due to severe dilated cardiomyopathy - EF 10-15%. He partially recovered after treatment - EF 28% and had early radioiodine treatment. Subject 3: A 42-year-old woman who had been thyrotoxic for several months (fT4: 54.3; fT3 >46.1; TSH <0.01; TRAb: 4.5) developed atrial fibrillation (AF) and heart failure. Echocardiography showed cardiomegaly - EF 29%. She maintains sinus rhythm following early total thyroidectomy (EF 50%). Significant cardiac complications may occur in previously fit young adults, who have had uncontrolled Graves' disease for weeks to months. Cardiac function recovers in the majority, but early definitive treatment should be discussed to avoid Graves' disease relapse and further cardiac decompensation. LEARNING POINTS Cardiac complications of Graves' disease are uncommon in young adults without previous cardiac disease. These complications may however occur if Graves' disease had been poorly controlled for several weeks or months prior to presentation. Persistent symptoms after adequate control should alert clinicians to the possibility of cardiac disease. Specific treatment of Graves' disease and appropriate cardiac intervention results in complete recovery in the majority and carries a good prognosis. Early definitive treatment should be offered to them to prevent cardiac decompensation at times of further relapse.
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Affiliation(s)
- J K Witczak
- Section of Endocrinology, Department of Medicine, Prince Phillip Hospital
- Centre for Endocrine and Diabetes Sciences, University Hospital of Wales, Heath Park, Cardiff, UK
| | - N Ubaysekara
- Centre for Endocrine and Diabetes Sciences, University Hospital of Wales, Heath Park, Cardiff, UK
| | - R Ravindran
- Centre for Endocrine and Diabetes Sciences, University Hospital of Wales, Heath Park, Cardiff, UK
| | - S Rice
- Section of Endocrinology, Department of Medicine, Prince Phillip Hospital
| | - Z Yousef
- Department of Cardiology, University Hospital of Wales, Heath Park, Cardiff, UK
| | - L D Premawardhana
- Centre for Endocrine and Diabetes Sciences, University Hospital of Wales, Heath Park, Cardiff, UK
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12
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Diabetic Ketoacidosis Associated with Thyroxine (T₄) Toxicosis and Thyrotoxic Cardiomyopathy. ACTA ACUST UNITED AC 2018; 54:medicina54060093. [PMID: 30486325 PMCID: PMC6306916 DOI: 10.3390/medicina54060093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 11/10/2018] [Accepted: 11/22/2018] [Indexed: 11/16/2022]
Abstract
Thyrotoxicosis and diabetic ketoacidosis (DKA) both may present as endocrine emergencies and may have devastating consequences if not diagnosed and managed promptly and effectively. The combination of diabetes mellitus (DM) with thyrotoxicosis is well known, and one condition usually precedes the other. Furthermore, thyrotoxicosis is complicated by some degree of cardiomyopathy in at least 5% de patients; but the coexistence of DKA, thyroxin (T4) toxicosis, and acute cardiomyopathy is extremely rare. We describe a case of a man, previously diagnosed with DM but with no past history of thyroid disease, who presented with shock and severe DKA that did not improve despite optimal therapy. The patient evolved with acute pulmonary edema, elevated troponin levels, severe left ventricular systolic dysfunction, and clinical and laboratory evidence of thyroxin (T4) toxicosis and thyrotoxic cardiomyopathy. Subsequently, the patient evolved favorably with general support and appropriate therapy for DKA and thyrotoxicosis (hydrocortisone, methimazole, Lugol’s solution) and was discharged a few days later.
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13
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Nai Q, Ansari M, Pak S, Tian Y, Amzad-Hossain M, Zhang Y, Lou Y, Sen S, Islam M. Cardiorespiratory Failure in Thyroid Storm: Case Report and Literature Review. J Clin Med Res 2018; 10:351-357. [PMID: 29511425 PMCID: PMC5827921 DOI: 10.14740/jocmr3106w] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 07/03/2017] [Indexed: 12/13/2022] Open
Abstract
Thyroid storm is a potentially fatal manifestation of thyrotoxicosis. Cardiopulmonary failure is the most common cause of death in thyroid storm. Clinicians should keep in mind that thyroid storm complicated with cardiopulmonary failure can be the first presentation of thyrotoxicosis. As early intervention is associated with improved patient outcome, prompt diagnosis based on clinical grounds is of paramount importance in the management of thyrotoxicosis. A high index of suspicion and the ability of early recognition of impending thyroid storm depends on a thorough knowledge of both the typical and atypical clinical features of this illness. Herein, we report a case of thyroid storm presenting as cardiopulmonary failure in a 51-year-old woman with undiagnosed Grave’s disease. Additionally, we review the pathophysiology of cardiopulmonary failure associated with thyrotoxicosis and various treatment modalities for thyroid storm.
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Affiliation(s)
- Qiang Nai
- Department of Medicine, University of Toledo Medical Center, Toledo, OH 43614, USA.,These authors contributed equally
| | - Mohammad Ansari
- Internal Medicine, Raritan Bay Medical Center, Perth Amboy, NJ 08861, USA.,These authors contributed equally
| | - Stella Pak
- Department of Medicine, University of Toledo Medical Center, Toledo, OH 43614, USA
| | - Yufei Tian
- Department of Medicine, University of Toledo Medical Center, Toledo, OH 43614, USA
| | - Mohammed Amzad-Hossain
- Department of Nephrology, New York Presbyterian Queens, 56-45 Main Street, Flushing, NY 11355, USA
| | - Yanhong Zhang
- Department of Pulmonary and Critical Care, Jefferson University, 834 Walnut Street, Suite 650, Philadelphia, PA 19107, USA
| | - Yali Lou
- Department of Neurology, Brigham and Women's Hospital, 60 Fenwood Road, Boston, MA 02115, USA
| | - Shuvendu Sen
- Department of Medicine, University of Toledo Medical Center, Toledo, OH 43614, USA
| | - Mohammed Islam
- Internal Medicine, Raritan Bay Medical Center, Perth Amboy, NJ 08861, USA
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14
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Morton A. Notes on Trauma-Related Thyroid Storm in the Emergency Department. J Emerg Med 2018; 54:e35. [PMID: 29428058 DOI: 10.1016/j.jemermed.2017.06.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 06/28/2017] [Indexed: 06/08/2023]
Affiliation(s)
- Adam Morton
- Mater Health, South Brisbane, Queensland, Australia; Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
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15
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Abstract
Thyroid hormones have a significant impact on cardiac function and structure. Excess thyroid hormone affects cardiovascular hemodynamics, leading to high-output heart failure and, in late stages, dilated cardiomyopathy. In this review, we discuss how hyperthyroidism affects cardiovascular pathophysiology and molecular mechanisms and examine the complications caused by excess thyroid hormone, such as heart failure and atrial fibrillation.
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16
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Choi YJ, Jang JH, Park SH, Oh JH, Koh DK. Dilated cardiomyopathy with Graves disease in a young child. Ann Pediatr Endocrinol Metab 2016; 21:92-5. [PMID: 27462586 PMCID: PMC4960021 DOI: 10.6065/apem.2016.21.2.92] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 12/02/2015] [Accepted: 12/08/2015] [Indexed: 11/20/2022] Open
Abstract
Graves disease (GD) can lead to complications such as cardiac arrhythmia and heart failure. Although dilated cardiomyopathy (DCMP) has been occasionally reported in adults with GD, it is rare in children. We present the case of a 32-month-old boy with DCMP due to GD. He presented with irritability, vomiting, and diarrhea. He also had a history of weight loss over the past few months. On physical examination, he had tachycardia without fever, a mild diffuse goiter, and hepatomegaly. The chest radiograph showed cardiomegaly with pulmonary edema, while the echocardiography revealed a dilated left ventricle with an ejection fraction (EF) of 28%. The thyroid function test (TFT) showed elevated serum T3 and decreased thyroid stimulating hormone (TSH) levels. The TSH receptor autoantibody titer was elevated. He was diagnosed with DCMP with GD; treatment with methylprednisolone, diuretics, inotropics, and methimazole was initiated. The EF improved after the TFT normalized. At follow-up several months later, although the TFT results again showed evidence of hyperthyroidism, his EF had not deteriorated. His cardiac function continues to remain normal 1.5 months after treatment was started, although he still has elevated T3 and high TSH receptor antibody titer levels due to poor compliance with drug therapy. To summarize, we report a young child with GD-induced DCMP who recovered completely with medical therapy and, even though the hyperthyroidism recurred several months later, there was no relapse of the DCMP.
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Affiliation(s)
- Yu Jung Choi
- Department of Pediatrics, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea
| | - Jun Ho Jang
- Department of Pediatrics, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea
| | - So Hyun Park
- Department of Pediatrics, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea
| | - Jin-Hee Oh
- Department of Pediatrics, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea
| | - Dae Kyun Koh
- Department of Pediatrics, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea
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