Takotsubo Cardiomyopathy Precipitated by Thyrotoxicosis

Alidjan, Fazil; Ezzhati, Mustafa; Bruggeling, W. A. J.; Guldener, Coen van

doi:10.1089/thy.2009.0444

Cited by 15 publications

(9 citation statements)

References 4 publications

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“…1,2 Furthermore, several investigators have noted a link between thyroid disease and TC 3,4 ; however, to our knowledge, recurrent TC related to thyroid dysfunction has not been described. We report a case of recurrent TC's potential link with recurrent hyperthyroidism.…”

mentioning

confidence: 96%

Recurrent Takotsubo Cardiomyopathy Related to Recurrent Thyrotoxicosis

Patel¹,

Griffing²,

Hauptman³

et al. 2016

Texas Heart Institute Journal

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Takotsubo cardiomyopathy, or transient left ventricular apical ballooning syndrome, is characterized by acute left ventricular dysfunction caused by transient wall-motion abnormalities of the left ventricular apex and mid ventricle in the absence of obstructive coronary artery disease. Recurrent episodes are rare but have been reported, and several cases of takotsubo cardiomyopathy have been described in the presence of hyperthyroidism. We report the case of a 55-year-old woman who had recurrent takotsubo cardiomyopathy, documented by repeat coronary angiography and evaluations of left ventricular function, in the presence of recurrent hyperthyroidism related to Graves disease. After both episodes, the patient's left ventricular function returned to normal when her thyroid function normalized. These findings suggest a possible role of thyroid-hormone excess in the pathophysiology of some patients who have takotsubo cardiomyopathy.

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confidence: 96%

Recurrent Takotsubo Cardiomyopathy Related to Recurrent Thyrotoxicosis

Patel¹,

Griffing²,

Hauptman³

et al. 2016

Texas Heart Institute Journal

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“…Similar theories have been proposed for the clinical setting of thyrotoxicosis; the majority of previous case reports have occurred in patients with Graves' disease (3). While there is no direct evidence, it may be plausible to suggest that antithyroid antibodies also play a role.…”

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confidence: 63%

Takotsubo Cardiomyopathy Complicating Thyroidectomy for Graves' Disease

Gundara

Lee

et al. 2012

Thyroid

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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].…”

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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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Takotsubo Cardiomyopathy Precipitated by Thyrotoxicosis

Cited by 15 publications

References 4 publications

Recurrent Takotsubo Cardiomyopathy Related to Recurrent Thyrotoxicosis

Recurrent Takotsubo Cardiomyopathy Related to Recurrent Thyrotoxicosis

Takotsubo Cardiomyopathy Complicating Thyroidectomy for Graves' Disease

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

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