Congestive Heart Failure Due to Reversible Cardiomyopathy in Patients With Hyperthyroidism

Umpiérrez, Guillermo E.; Challapalli, Sridevi; Patterson, Cam

doi:10.1097/00000441-199531030-00003

Cited by 63 publications

(32 citation statements)

References 22 publications

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“…[4] In a study of a series of 7 patients with hyperthyroidism and congestive heart failure, the mean LVEF increased from 28% to 55% after treatment for thyrotoxicosis. [5] There were other similar reports so that it is generally accepted that an appropriate treatment with hyperthyroidism leads to reverse LV contractility.…”

Section: Discussionmentioning

confidence: 94%

Rapid Improvement of thyroid storm-related hemodynamic collapse by aggressive anti-thyroid therapy including steroid pulse

Kohno¹,

Amiya²,

Hatano³

et al. 2017

Medicine

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Rationale:Heart failure is relatively common in patients with hyperthyroidism, but thyrotoxic cardiomyopathy with poor left ventricular (LV) systolic function is very rare.Patient concerns:We experienced a representative case of a patient who presented with severe LV dysfunction related to thyroid storm and needed extracorporeal membrane oxygenation (ECMO) temporally.Diagnosis:Thyrotoxic cardiomyopathy.Interventions and Outcomes:Aggressive antithyroid therapy, including steroid pulse to hyperthyroidism, leads to the dramatic improvement of cardiac function and she was successfully weaned from ECMO.Lessons:The most outstanding feature of the current case was the rapid decrease of cardiac injury and improvement of cardiac function by strengthening antithyroid therapy, including steroid pulse, without thyroid hormone level normalization. In thyroid storm, various systemic inflammatory reactions have different time courses and among them, the cardiac phenotype emerges in most striking and critical ways.

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Section: Discussionmentioning

confidence: 94%

Rapid Improvement of thyroid storm-related hemodynamic collapse by aggressive anti-thyroid therapy including steroid pulse

Kohno¹,

Amiya²,

Hatano³

et al. 2017

Medicine

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“…1,15 Studies of this association have found it to be an uncommon manifestation of hyperthyroidism generally. 21 It also reduces LVEF in 3% of cases. 22 Li et al 23 suggested that for the Graves' disease patients with the higher thyroid hormone of FT4 > 70.5 pmol/L and at the same time with the heart rate above 90 times per minute, the risk of hepatic function injury would increase.…”

Section: Discussionmentioning

confidence: 97%

Hyperthyroidism and hepatic dysfunction: Report of 17 cases

et al. 2020

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Aims: Hyperthyroidism has been known to be associated with abnormalities of serum liver chemistry. The objective of our study is to describe clinical, biochemical and therapeutic features of hepatic dysfunction in hyperthyroidism. Methods and Results: This retrospective study was conducted on patients hospitalized in our endocrinology department over 20 years. We included patients with untreated and noniatrogenic hyperthyroidism among whom biochemical findings noted hepatic dysfunction and excluded those with concomitant liver disease. Our population is composed of 10 men and 7 women. The average age was 41.4 years. The mean serum level of free thyroxine was 83.8 pmol/L. The serum thyrotropin level was below the detection limit in 10/17 cases. Graves' disease was the most frequently found etiology of hyperthyroidism. Fourteen patients had hyperthyroidism's complications. Eleven patients manifested congestive heart failure. Hepatic dysfunction was moderate and severe in eight and two cases, respectively. Fifteen patients had cholestasis, associated with jaundice in five cases. Hepatocellular injury and synthetic liver dysfunction were noted in seven and five cases, respectively. Thyroid peroxidase antibodies were positively correlated with the serum level of bilirubin (ρ = 0.695; P = 0.038). A negative correlation was noted between alanine aminotransferase and left ventricular ejection fraction (ρ = −0.812; P = 0.05). Radioactive iodine was indicated in 15/17 cases. Follow-up liver tests were performed in 11 cases. They all had normalized hepatic function once euthyroidism restored. Conclusion: Liver injury in hyperthyroidism is relatively common, ranging from mild to severe. Therefore, patients presenting unexplained hepatic abnormalities require close examination and an evaluation of the thyroid function should be sought.

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“…Congestive heart failure exacerbation, often secondary to atrial fibrillation but also described in sinus tachycardia, has a recognized association with hyperthyroidism. Studies of this association have found it to be an uncommon manifestation of hyperthyroidism generally, although research specifically investigating patients with acute thyrotoxicosis is limited [17]. It seems likely that congestive heart failure is more common in this population and serves as a potential confounding variable as it is a well-recognized cause of acute liver dysfunction and disordered LFTs.…”

Section: Discussionmentioning

confidence: 99%

Hepatic Dysfunction in Hospitalized Patients with Acute Thyrotoxicosis: A Decade of Experience

2012

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Thyroid disease is a common condition, and thyroid hormone excess or deficiency is known to have wide-ranging effects on a variety of organ systems. Our objective is to describe the magnitude, biochemical features, and clinical characteristics of hepatic abnormalities in patients with acute thyrotoxicosis. We performed a retrospective review of all patients admitted to our institution between January 1, 1998 and December 31, 2008 with a discharge diagnosis of acute thyrotoxicosis excluding iatrogenic causes. The records of these patients were reviewed and data extracted regarding demographic, biochemical, and clinical data particularly relevant to liver function. Fourteen patients were identified of which eleven had liver studies performed. The majority (90.9%) had Graves disease. Nine of eleven patients (81.8%) had some degree of hepatic abnormality. Seven patients (63.6%) had an elevation in one or both transaminases, and two (18.2%) had isolated synthetic dysfunction as manifested as an elevated INR and/or decreased albumin without transaminitis. The mean magnitude of deviation from the normal range was greater in the transaminases as compared to bilirubin, INR, or albumin. Definitive treatment was radioiodine ablation in six cases (54.5%) and surgical thyroidectomy in two cases (18.2%). Noniatrogenic acute thyrotoxicosis requiring hospitalization is a rare condition which is most frequently caused by Graves disease. The majority of patients have disordered liver tests of a highly variable nature, making the recognition of this association important in the care of patients presenting with acute thyrotoxicosis.

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Congestive Heart Failure Due to Reversible Cardiomyopathy in Patients With Hyperthyroidism

Cited by 63 publications

References 22 publications

Rapid Improvement of thyroid storm-related hemodynamic collapse by aggressive anti-thyroid therapy including steroid pulse

Rapid Improvement of thyroid storm-related hemodynamic collapse by aggressive anti-thyroid therapy including steroid pulse

Hyperthyroidism and hepatic dysfunction: Report of 17 cases

Hepatic Dysfunction in Hospitalized Patients with Acute Thyrotoxicosis: A Decade of Experience

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