Takotsubo cardiomyopathy associated with thyrotoxicosis: a case report and review of the literature

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.

FIG. 1.

Left ventriculogram with wall motion abnormalities in the distal segments and normal wall motion in basal segments (arrows) comparable to stress-induced cardiomyopathy. (a) Diastolic phase. (b) Systolic phase.

FIG. 2.

Diagram of patient's heart rate (HR) in relation to treatment with beta-blockers.

FIG. 3.

Thyroid function tests during hospital course and outpatient follow-up visits. TSH, thyrotropin; T4, thyroxine.