Broken heart syndrome triggered by an obstructive goiter not associated with thyrotoxicosis

Hatzakorzian, Roupen; Bui, Helen; Schricker, Thomas; Backman, Steven B.

doi:10.1007/s12630-013-9964-0

Cited by 5 publications

(2 citation statements)

References 19 publications

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“…The association between thyrotoxicosis and cardiac complications is well known, yet thyrotoxicosis induced stress cardiomyopathy is rare [11]. TCM was reported in association with varied thyroid functional status, ranging from severe hypothyroidism [12], apathetic [13] or subclinical hyperthyroidism [14], endogenous or exogenous thyrotoxicosis [15,16], transient hyperthyroidism [17], thyroid storm [11,18] to even normal thyroid function [19]. TCM was also reported following radioiodine therapy [20] or surgical treatment for thyroid disorders [21].…”

Section: Discussionmentioning

confidence: 99%

Takotsubo cardiomyopathy and transient thyrotoxicosis during combination therapy with interferon-alpha and ribavirin for chronic hepatitis C

et al. 2014

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Background: Thyroid dysfunction is a common complication of chronic hepatitis C (CHC) and its therapy. Takotsubo cardiomyopathy (TCM) is a multifactorial, stress related cardiomyopathy, rarely reported in association with thyrotoxicosis. Simultaneous occurrence of TCM and thyrotoxicosis due to hepatitis C and its treatment has never been reported. Case presentation: A 47-year-old woman was admitted for acute chest pain, dyspnea, palpitations and diaphoresis. She had been diagnosed with CHC and had undergone 7 months of IFNα and Ribavirin therapy. At admission electrocardiogram (ECG) showed ST segment elevation, negative T waves and troponin was elevated suggesting ST segment elevation myocardial infarction (STEMI). Echocardiography demonstrated left ventricular apical akinesia and ballooning, with a left ventricular ejection fraction (LVEF) of 35%. Contrast angiography showed normal epicardial coronaries, yet a ventriculogram revealed left ventricular apical ballooning, consistent with TCM. Cardiac MRI showed left ventricle apical ballooning and no late enhancement suggesting the absence of any edema, scar or fibrosis in the left myocardium. She was diagnosed with non-autoimmune destructive thyroiditis: TSH=0.001 mU/L, free T4=2.41 ng/dl, total T3=199 ng/dl and negative thyroid antibodies. The thyroid ultrasonography showed a diffuse small goiter, no nodules and normal vascularization of the parenchyma. Following supportive treatment she experienced a complete recovery after a few weeks and she successfully completed her antiviral treatment, with no thyroid or cardiovascular dysfunction ever since. In patients treated with IFNα for CHC, the prevalence of thyroid dysfunction varies between 2.5-45.3% of cases. TCM is a stress related cardiomyopathy characterized by elevated cardiac enzymes, normal coronary angiography and an acute, transient, left ventricular apical dysfunction that mimics myocardial infarction. Most of the patients survive the initial acute event, typically recover normal ventricular function within one to four weeks and have a favorable outcome, as was the case with our patient. Thyrotoxicosis induced stress cardiomyopathy is rare and has been mostly reported in association with Graves' disease, thyroid storm, thyrotoxicosis factitia or following radioiodine therapy for toxic multinodular goiter. Conclusion: Routine thyroid screening should be done in patients receiving IFN-alpha and Ribavirin for CHC and thyrotoxicosis should be considered as a possible and treatable underlying cause of TCM.

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Section: Discussionmentioning

confidence: 99%

Takotsubo cardiomyopathy and transient thyrotoxicosis during combination therapy with interferon-alpha and ribavirin for chronic hepatitis C

et al. 2014

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“…Various authors have reported possible association of TC and hyperadrenergic state [3]. There have been few case reports published for possible link between varied thyroid functional status and TC, ranging from severe hypothyroidism, apathetic or subclinical hyperthyroidism, endogenous or exogenous thyrotoxicosis, transient hyperthyroidism, thyroid storm, euthyroid status, following radioiodine therapy and surgical treatment for thyroid disorders [4][5][6]. However, clinical study to define association of thyroid status with TC is still lacking.…”

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confidence: 99%

Can thyroid break your heart? Role of thyroid in Takotsubo cardiomyopathy: A single center retrospective study

Aggarwal

Papani

Gupta

2015

International Journal of Cardiology

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Stress cardiomyopathy following thyroidectomy in a postmenopausal patient: A case report

Atanasova,

Sokolov,

Popov

et al. 2024

International Journal of Surgery Case Reports

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Broken heart syndrome triggered by an obstructive goiter not associated with thyrotoxicosis

Cited by 5 publications

References 19 publications

Takotsubo cardiomyopathy and transient thyrotoxicosis during combination therapy with interferon-alpha and ribavirin for chronic hepatitis C

Takotsubo cardiomyopathy and transient thyrotoxicosis during combination therapy with interferon-alpha and ribavirin for chronic hepatitis C

Can thyroid break your heart? Role of thyroid in Takotsubo cardiomyopathy: A single center retrospective study

Stress cardiomyopathy following thyroidectomy in a postmenopausal patient: A case report

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