Takotsubo cardiomyopathy in the setting of thyroid storm

Abstract

A woman in her 50s with a background of chronic obstructive pulmonary disease secondary to smoking presented with intermittent chest tightness, dyspnoea and vomiting for 4 days. A presumed diagnosis of acute coronary syndrome (ACS) was made based on dynamic ischaemic ECG changes and elevation in high-sensitivity cardiac troponin T levels. She underwent emergent coronary angiography which demonstrated mild coronary artery disease with left ventriculography suggestive of mid-wall variant Takotsubo cardiomyopathy. Thyroid function tests performed to investigate sinus tachycardia were consistent with hyperthyroidism, and her thyroid-stimulating hormone receptor antibody was elevated. A diagnosis of thyroid storm was made in the setting of a newly diagnosed Graves’ disease and the patient was subsequently commenced on guideline-based therapy. This case demonstrates that Takotsubo cardiomyopathy, a mimic of ACS, is a possible complication of thyroid storm and therefore hyperthyroidism should be considered in the list of differentials in patients presenting with Takotsubo cardiomyopathy.

Transient Mid-Ventricular Ballooning Syndrome: An Atypical Variant of Stress Cardiomyopathy

“…Thyroid cardiomyopathy in a patient with an underlying history of Graves’ disease should be on top of the differentials. Thyroid hormones have similar effects to catecholamine-mediated sympathetic stimulation of beta-adrenergic receptors [ 23 ], and multiple cases have been reported in the literature with Takotsubo cardiomyopathy in the setting of abnormal thyroid hormone levels including atypical variants: mid-wall variant Takotsubo [ 24 ]. Graves’ disease in our case was clinically in remission, and thyroid-stimulating hormone was also within normal limits making hyperthyroid cardiomyopathy less likely; however, it is important to highlight the role of thyroid function testing in clinically appropriate settings.…”

Data Analysis and Systematic Scoping Review on the Pathogenesis and Modalities of Treatment of Thyroid Storm Complicated with Myocardial Involvement and Shock

“…Takotsubo cardiomyopathy is seen in 17.7% of thyroid diseases, of which 5.9% are attributed to hyperthyroidism [31]. TCMP is also defined as stress cardiomyopathy and broken heart syndrome that can lead to transient or reversible heart failure [46,50]. An increase in thyroid hormone levels above the normal range leads to intensified adrenergic activity, resulting in stress-induced cardiomyopathy [28,46].…”