Thyrotoxicosis-Induced Ventricular Arrhythmias

Nadkarni, Powlimi J.; Sharma, Madhu; Zinsmeister, Bruce; Wartofsky, Léonard; Burman, Kenneth D.

doi:10.1089/thy.2007.0307

Cited by 23 publications

(17 citation statements)

References 19 publications

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“…Ischemic heart disease is another cause of Vf seen in patients with thyrotoxicosis, probably because thyroid hormone is known to increase cardiac oxygen consumption (2). Thus, it is even rarer for thyrotoxic patients not accompanying hypokalemic periodic paralysis to develop Vf without ischemic heart disease (10)(11)(12)(13)(14) or with stable coronary disease (15). We present three cases of GD complicated by idiopathic Vf without hypokalemic periodic paralysis or ischemic heart disease.…”

Section: Introductionmentioning

confidence: 95%

Graves' Disease Complicated by Ventricular Fibrillation in Three Men Who Were Smokers

Ando

Henmi²,

Haruta³

et al. 2011

Thyroid

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Background: Thyrotoxicosis is known to be associated with sinus tachycardia and supraventricular tachyarrhythmias, but rarely with ventricular fibrillation (Vf), which has only occurred in some patients with hypokalemic periodic paralysis or ischemic heart disease. Patient Findings: We present three men who were transferred to our hospital with Graves' disease who developed idiopathic Vf. None of them had hypokalemic periodic paralysis or ischemic heart disease but all were smokers. None of other patients with thyrotoxicosis (587 females and 155 males) who were seen at our hospital, in the period during which the three men were seen, had idiopathic Vf. In our three men with thyrotoxicosis and idiopathic Vf, there was no identifiable underlying heart disease. One of the three patients died of hypoxic encephalopathy. The other two men did not have recurrent Vf after their thyroid function normalized. Summary: These cases and a review of similar cases in the literature imply that improving thyrotoxicosis seems to be effective for treating idiopathic Vf in some patients. Conclusions: Our findings suggest that thyroid hormone excess might play a direct role in the development of Vf in susceptible individuals. Our experience with these three patients suggests that smoking men with thyrotoxicosis likely have an increased risk for Vf, even if they do not have other predisposing factors.

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Section: Introductionmentioning

confidence: 95%

Graves' Disease Complicated by Ventricular Fibrillation in Three Men Who Were Smokers

Ando

Henmi²,

Haruta³

et al. 2011

Thyroid

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“…In most cases describing SCA in thyroid storm, the underlying thyroid pathology is GD, either as a first presentation9–11 or due to discontinuation of medication,12 13 such as in our case. However, thyroid storm with subsequent SCA may also occur in other thyroid conditions, including iatrogenic thyrotoxicosis (amiodarone13 or iodine contrast-induced) 14.…”

Section: Discussionmentioning

confidence: 68%

Section: Discussionmentioning

confidence: 99%

“…However, thyroid storm with subsequent SCA may also occur in other thyroid conditions, including iatrogenic thyrotoxicosis (amiodarone13 or iodine contrast-induced) 14. Underlying structural heart disease plays a role in some of these,13 but not in all 9–12. A Brugada pattern has never been reported in association with thyroid storm, but did occur in a case of hypokalaemic periodic paralysis as a complication of thyrotoxicosis 15…”

Section: Discussionmentioning

confidence: 99%

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Sudden cardiac arrest as a presentation of Brugada syndrome unmasked by thyroid storm

et al. 2015

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An 18-year-old man suffered a sudden cardiac arrest with ventricular fibrillation and was successfully resuscitated. He had neither a medical nor family history of cardiac disease/sudden death, but was known to have Graves' disease, for which he was treated with radioactive iodine. Recently, block-and-replacement therapy had been discontinued to evaluate thyroid functioning. On admission, thyroid hormone levels were markedly elevated, suggesting thyroid storm due to residual Graves' disease. The patient was treated with propylthiouracil, hydrocortisone and Lugol solution. ECG showed repolarisation patterns suggestive of an underlying type 1 Brugada syndrome (BS). These findings were confirmed by an additional ajmaline test. An implantable cardioverter defibrillator was implanted to prevent future arrhythmias. The patient underwent total thyroidectomy 9 months later and recovered completely. To the best of our knowledge, this is the first reported case of a sudden cardiac arrest as a presentation of BS unmasked by thyroid storm.

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“…The heart rate increases due to increased sinoatrial activity, a lower threshhold for atrial activity and shortened atrial repolarization [28,29]. These last 2 factors also create a favourable substrate for the generation of AF, and a similar effect on ventricular myocardium has been linked with ventricular arrythmias [30]. Volume preload increases due to activation of renin angiotensin system [31].…”

Section: Discussionmentioning

confidence: 99%

Non Atrial Fibrillation related Central Retinal Artery Occlusion (CRAO) in Hyperthyroidism: A Case Report

et al. 2015

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We report a case of non AF related Central retinal artery occlusion (CRAO) (Stroke) in untreated & uncontrolled hyperthyroidism. CRAO can be considered as an ocular analogue of stroke or an ocular equivalent of acute myocardial infarction. Generally hyperthyroidism is associated with Stroke (CRAO) because of atrial fibrillation. However, we report a case of uncontrolled hyperthyroidism with CRAO in the absence of atrial fibrillation. It is with an intent to highlight the fact that a hyperthyroid state is not only complicated by AF, but even hyperthyroidism in itself is a potential risk factor in the causation of stroke.We came across only one case report of ischaemic stroke in a hyperthyroid patient without AF. We could not find any case report of hyperthyroidism with AF related CRAO in literature. Hence we report first case of non AF related CRAO in hyperthyroidism & perhaps second case report of non AF related stroke in hyperthyroidism in literature so far. An uncontrolled hyperthyroid state is tantamount to a sustained inflammatory state that results in endothelial dysfunction by causing hypercoagulable state culminating in a small calibre vessel blockage.

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Thyrotoxicosis-Induced Ventricular Arrhythmias

Abstract: Prompt attention to the management of thyrotoxicosis in patients with a history of significant heart disease is warranted in order to avoid potentially fatal arrhythmias.

Cited by 23 publications

References 19 publications

Graves' Disease Complicated by Ventricular Fibrillation in Three Men Who Were Smokers

Graves' Disease Complicated by Ventricular Fibrillation in Three Men Who Were Smokers

Sudden cardiac arrest as a presentation of Brugada syndrome unmasked by thyroid storm

Non Atrial Fibrillation related Central Retinal Artery Occlusion (CRAO) in Hyperthyroidism: A Case Report

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