Myocarditis associated with Hashimoto’s disease: a case report

Abstract

We report on a sudden cardiac death case involving a 40-year-old man with no known medical history. Forensic autopsy showed lymphocytic myocarditis associated with lymphocytic thyroiditis. In both the heart and the thyroid gland, the inflammatory foci often had a nodular pattern with a germinal centre. Virological and toxicological analyses were negative. Postmortem biochemistry showed a slight increase in TSH in combination with normal T3 and T4 blood levels suggesting hypothyroidism. High titres of antiperoxidase and antithyroglobulin antibodies with normal levels of TSH receptor antibodies, in addition to biological hypothyroidism and lymphocytic inflammation were consistent with the diagnosis of Hashimoto's thyroiditis. Immunohistochemical studies excluded a lymphoma and showed no evidence of viral myocarditis. In contrast to Grave's disease, Hashimoto's thyroiditis has never been reported in association with myocarditis as a cause of sudden death. We conclude that the cardiac immunological and histological pattern, similar to that found in the thyroid gland suggests an autoimmune myocarditis.

Sudden cardiac death due to hypersensitivity myocarditis during clozapine treatment

“…Postmortem examination [16,17], using a complete immunohistochemical panel [18,19], is warrant for the diagnosis of the disease, having a high index of diagnostic suspicion in patients who died during clozapine treatment associated with peripheral eosinophilia [20].…”

Thyroid Storm and Lymphocytic Myocarditis

“…Myocarditis has been observed in patients with TSH-receptor autoantibody positive Graves hyperthyroidism (9). Only one case of verified myocarditis has been reported in a euthyroid Hashimoto patient (10 …”

Vogt-Koyanagi-Harada syndrome associated to hypothyroidism revealed by myocarditis

“…This achievement, in type of hypo kinesis septal or dilated cardiomyopathy, is caused by reversible myocardial functional impairment. In Hashimoto's thyroiditis, lymphocytic myocarditis of probable autoimmune origin was reported in an autopsy study [13]. Treatment of VKH syndrome is based on steroids and immunosuppressors and treatment of hypothyroidism is substitutive thyroid hormone.…”

“…Treatment of VKH syndrome is based on steroids and immunosuppressors and treatment of hypothyroidism is substitutive thyroid hormone. Captopril establishes myocarditis; when due to hypothyroidism, it is also reversible when hormonal disorder is early corrected [1,7,11,13].…”