Thyrotoxicosis-Induced Cardiomyopathy With Systolic Dysfunction

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.

Keywords: congestive heart failure; dilated cardiomyopathy; hyperthyroidism; systolic dysfunction; thyrotoxicosis.

Figure 1. CTPA of the chest showing no signs of pulmonary embolism, patchy ground glass opacities within the lingula and left lower lobe, mild dependent changes with subsegmental atelectasis within the bilateral lower lobes, and mildly enlarged main pulmonary artery (black arrows)

CTPA: computed tomography pulmonary angiogram

Figure 2. Upright X-ray showing mild cardiomegaly (black arrows)

X-ray: X-radiation

Figure 3. ECG on admission depicting tachycardia and ventricular hypertrophy in leads 4-6

ECG: electrocardiography

Figure 4. Nuclear medicine myocardial perfusion SPECT

SPECT: single-photon emission computed tomography