Takotsubo Cardiomyopathy Associated with Thyrotoxicosis: A Case Report and Review of the Literature

Abstract

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.

Takotsubo syndrome: aetiology, presentation and treatment

“…Wittstein and colleagues measured circulating catecholamine levels in the blood of a cohort of patients with TTS and reported levels that were 10–20 times higher than normal, and higher than matched patients with acute left anterior descending artery occlusion and ST segment elevation myocardial infarction (STEMI),14 although others could not replicate this finding. Clinical conditions associated with high catecholamine levels, including pheochromocytoma,15 acute subarachnoid haemorrhage with sympathetic storm16 and acute thyrotoxicosis,17 have been reported to cause TTS. Perhaps the most robust evidence is from the cohorts of patients reported where TTS was triggered by administration of epinephrine or dobutamine, either for medical reasons or by accident 18.…”

Stress-Induced Cardiomyopathy

“…In addition, stress-induced cardiomyopathy has been described in the postpartum period as an entity distinct from a peripartum myopathy. Thyrotoxicosis can precipitate stress-induced cardiomyopathy, and proposed mechanisms suggest that hyperthyroidism can mimic a state of hyperadrenergic activity (43). However, this attenuation by estrogen fails to explain the overall predilection for females to be affected by stress-induced cardiomyopathy.…”

Thyroid Storm Precipitated by Diabetic Ketoacidosis and Influenza A: A Case Report and Literature Review

“…Applying the diagnostic criteria of Burch & Wartofsky, a score of 45 or greater was considered to indicate thyroid storm. Eighteen English-language cases, including the present case, were considered to be cases of thyroid storm with DKA (Table 2) (6-20). The mean age of these cases was 37.4 years (male 2; female 16).…”