Thyrotoxic Cardiomyopathy Research Articles

Prevalence and Risk Factors of Heart Failure in Patients Diagnosed with Hyperthyroidism: A Systematic Review and Meta-analysis.

Objectives: Hyperthyroidism has a significant impact on the cardiovascular system, causing thyrotoxic cardiomyopathy, which is characterized by atrial fibrillation, left ventricular hypertrophy and diastolic dysfunction, and may lead to heart failure. This study aimed to investigate the prevalence and associated risk factors for heart failure in patients with hyperthyroidism. Methods: A systematic literature search was conducted on PubMed, SCOPUS and Ovid SP up until April 2023. Pooled prevalence and pooled odds ratio for risk factors were calculated using the generic inverse variance method. Results: Studies involving 30,889 patients were included in this meta-analysis. The overall prevalence of heart failure in patients with hyperthyroidism was 8% (95% confidence interval [CI]: 6-11%). Further analyses revealed that the prevalence of heart failure in patients who underwent treatment with radioactive iodine ablation, antithyroid medication and thyroidectomy was 8% (95% CI: -1 to 16%), 6% (95% CI: 2 to 11%) and 4% (95% CI: -2 to 10%), respectively. The risk factors of heart failure in hyperthyroidism include atrial fibrillation, chronic kidney disease, anaemia, hypertension, history of stroke or transient ischaemic attack, history of coronary artery disease and diabetes mellitus. Conclusion: Heart failure occurs in 8% of patients with hyperthyroidism, with the most common risk factor being atrial fibrillation.

8630 Cardiorespiratory Failure in Thyroid Storm After C-section in a Patient with Untreated Hyperthyroidism

Abstract Disclosure: I.C. Arroyo: None. M. Ramirez: None. M. Alvarado: None. L.R. Sepulveda-Garcia: None. L. El Musa Penna: None. W. Medina-Torres: None. Z. Maisonet -Feliciano: None. J. Segarra-Villafane: None. Unrecognized hyperthyroidism during pregnancy increases the risk of maternal and fetal complications, including miscarriage, pre-eclampsia, maternal congestive heart failure, and intrauterine growth restriction (IUGR). Thyroid storm is a rare but life-threatening complication that can occur as well. Furthermore, it can present with cardiopulmonary failure which increases risk of death. Recognizing it early and providing intensive and ongoing therapy is imperative for a positive outcome.We report a case of a 29-year-old female G4P2A0 with triplet pregnancy who developed thyroid storm after an emergency C-section at 27 weeks of gestation due to sinus tachycardia and IUGR in one of the fetuses.Past medical history was remarkable for hyperthyroidism diagnosed on first pregnancy that did not require treatment.Upon questioning, she referred unintentional weight loss, palpitations, tremors, and heat intolerance in the past months.Physical examination showed sinus tachycardia, fine hand tremors, non-tender goiter, and thin/brittle hair.One day after C-section thyroid function tests (TFT) were remarkable for suppressed TSH <0.008uIU/mL, FT4 at 4.30 (0.89-1.76ng/dL) and positive thyroid stimulating antibodies. Burch-Warsofsky Point Scale (BWPS) for Thyrotoxicosis of 20 points didn’t indicate current or impending thyroid storm. Methimazole and propranolol were started. Two days after C- section patient developed worsening FT4 at 5.63ng/dl, worsening sinus tachycardia, increased temperature and respiratory failure requiring mechanical intubation. 2 D echocardiogram showed right ventricular overload with pulmonary hypertension, while CT angiogram of thorax suggested thyrotoxic cardiomyopathy. BWPS was now at 45 points compatible with thyroid storm (positive criteria for temperature of 38.4, heart rate of 117 bmp and heart failure). At this time methimazole was switched to propylthiouracil (PTU), propranolol was adjusted, and hydrocortisone, in addition to cholestyramine, were started. After these changes in therapy, TFTs improved markedly and a stable clinical state was achieved, with successful extubation.Untreated hyperthyroidism during pregnancy and post-partum period poses significant risks, including thyroid storm. Our patient had a C-section with worsening TFTs despite methimazole therapy, developing thyroid storm with cardiopulmonary failure. Cardiopulmonary failure is a rare, but deadly presentation of thyroid storm. In this case C-section was identified as a stressor for thyroid storm and cardiorespiratory failure as a complication. Prompt recognition and aggressive treatment of this potentially lethal condition is warranted to improve survival in thyrotoxic cardiomyopathy. Presentation: 6/1/2024

6724 A Broken Heart Due to Excess Thyroid

Abstract Disclosure: R. Subramani: None. R. Subramani: None. V. Zeykan: None. Introduction: Tachycardia-induced cardiomyopathy related to thyrotoxicosis is an uncommon yet serious complication affecting fewer than 1% of individuals with hyperthyroidism. Restoring a euthyroid state can potentially reverse the abnormal cardiac structure and function. Here we report a case of tachycardia-induced cardiomyopathy secondary to thyrotoxicosis Case Summary: A 52-year-old woman with a history of hypertension presented with recent-onset exertional dyspnea, a nonproductive cough, and paroxysmal nocturnal dyspnea. On examination, she exhibited tachycardia (heart rate: 150/min), tachypnea, hypertension, and was afebrile. Physical findings included a mildly enlarged, firm, non-tender thyroid gland bilaterally, without exophthalmos or tremors. Auscultation revealed bilateral crackles in the left lower lung fields. Laboratory analysis revealed undetectable TSH (<0.02 uIU/mL), elevated free T4 (5.3 ng/dL), free T3 (16.30 pg/mL), thyroid stimulating immunoglobulin (TSI) at 216%, and NT proBNP at 8528 pg/mL. Neck ultrasound and CT confirmed diffuse enlargement of the thyroid gland. Transthoracic echocardiography (TTE) displayed severely depressed left ventricular systolic function, estimating an ejection fraction (EF) of 25-30%. Initial management involved intravenous beta-blockers for heart rate control, IV Lasix, and IV hydrocortisone. Subsequently, the patient received propylthiouracil, propranolol, and prednisone, resulting in symptomatic improvement. A follow-up TTE after 6 months revealed an improved EF of 50%. Discussion: The pathophysiologic mechanisms underlying thyrotoxic cardiomyopathy encompass several factors, including tachycardia-induced cardiomyopathy, direct myopathic effects induced by the T3 hormone, and concurrent autoimmune myocarditis associated with Graves' disease. Thyroid hormone exerts a comprehensive impact on nearly all tissue and organ systems, heightening basal metabolic rate and subsequently increasing preload, myocardial contractility, and cardiac output. While thyrotoxicosis-related congestive heart failure (CHF) is relatively uncommon among patients hospitalized for acute CHF, addressing hyperthyroidism and CHF through definitive treatment yields a more favorable prognosis compared to cases of acute CHF stemming from other etiologies. The intricate interplay of these mechanisms highlights the importance of a comprehensive approach in managing thyrotoxic cardiomyopathy, emphasizing the need for targeted interventions to address both the underlying thyroid dysfunction and associated cardiac manifestations. Presentation: 6/3/2024

Anaesthetic management of feline patients diagnosed with hyperthyroidism

Cats with hyperthyroidism may need sedation or general anaesthesia for a variety of reasons, including elective procedures such as blood sampling, dental procedures and radiographs, as well as for surgical excision of all or part of the thyroid. The clinical implications of hyperthyroidism make sedation and general anaesthesia of these patients challenging. When formulating an appropriate anaesthetic plan, an understanding of thyroid physiology and pathophysiology is essential. An appreciation of how comorbidities associated with hyperthyroidism, such as senior or geriatric status, chronic kidney disease and thyrotoxic cardiomyopathy, affects anaesthesia is important. This article discusses these topics, as well as drug choices, analgesia, monitoring and fluid therapy.

Relapsed thyrotoxicosis presenting as thyroid storm with likely thyrotoxic cardiomyopathy and acting as a trigger for diabetic ketoacidosis

Relapsed thyrotoxicosis presenting as thyroid storm with likely thyrotoxic cardiomyopathy and acting as a trigger for diabetic ketoacidosis

Reversible acute heart failure induced by thyrotoxic cardiomyopathy: A case report.

Thyrotoxic cardiomyopathy is a rare but severe complication of thyrotoxicosis, leading to episodes of acute heart failure. This case report highlights a rare presentation of thyrotoxic cardiomyopathy with low-output heart failure, emphasizing the importance of early diagnosis and comprehensive management. The report aims to increase awareness among clinicians about the potential reversibility of this condition and the effective strategies for managing such complex cases. This patient presented with dyspnea and chest constriction, without any antecedent predisposing factors. Subsequently, the patient abruptly manifested symptoms indicative of acute heart failure during outpatient consultation. Electrocardiography revealed rapid atrial fibrillation with type A preexcitation syndrome, whereas cardiac ultrasonography demonstrated global cardiac enlargement with a diminished ejection fraction (EF). After a comprehensive evaluation, the patient was diagnosed with thyrotoxic cardiomyopathy, acute heart failure, and atrial fibrillation with preexcitation syndrome. Immediate interventions comprised diuretic administration, oxygen therapy, and antiarrhythmic agents, addressing acute heart failure concomitant with preexcitation syndrome. Following a fortnight of comprehensive therapeutic measures, the patient was discharged with a prescription for oral medications, notably methimazole. Following the intervention, the patient showed significant improvement with the resolution of heart failure symptoms and dyspnea, restoration of sinus rhythm, improved left ventricular ejection fraction (LVEF improved from 36% to 45%), and normalization of thyroid function. These outcomes underscore the efficacy of the intervention strategy and offer a hopeful prognosis for similar cases. Thyrotoxicosis may cause cardiomyopathy in patients with heart failure that manifests as dilated cardiac chambers. Clinicians should carefully screen patients for this reversible condition. Diagnosis requires a comprehensive assessment of various tests, and the therapeutic goal is to restore normal thyroid function.

Cardiovascular Complications of Hyperthyroidism

Thyrotoxicosis is a clinical syndrome caused by an excess of thyroid hormones circulating in the body. Myocardium and blood arteries have thyroid hormone receptors; hence, an increase or decrease in thyroid hormone levels can alter cardiovascular function. Cardiovascular complications are obvious in-patient with hyperthyroidism. Palpitations, tachycardia, exercise intolerance, dyspnea with exertion, expanded pulse pressure, and on occasion atrial fibrillation are associated with hyperthyroidism, excessive endogenous thyroid hormone production, and thyrotoxicosis, the condition caused by excess thyroid hormone. In the early stages of hyperthyroidism, a high cardiac output and hypertrophy of the left ventricle are observed, followed by biventricular dilatation and congestive heart failure. Atrial fibrillation and pulmonary arterial hypertension can contribute to the higher morbidity associated with untreated hyperthyroidism. Therefore, early and effective treatment of hyperthyroidism is required to prevent thyrotoxic cardiomyopathy.

Thyrotoxic Cardiomyopathy: State of the Art.

Thyroid hormones, mainly triiodothyronine, have genomic and non-genomic effects on cardiomyocytes related to the contractile function of the heart. Thyrotoxicosis, which is the set of signs and symptoms derived from the excess of circulating thyroid hormones, leads to increased cardiac output and decreased systemic vascular resistance, increasing the volume of circulating blood and causing systolic hypertension. In addition, the shortening of the refractory period of cardiomyocytes produces sinus tachycardia and atrial fibrillation. This leads to heart failure. Approximately 1% of patients with thyrotoxicosis develop thyrotoxic cardiomyopathy, a rare but potentially fatal form of dilated cardiomyopathy. Thyrotoxic cardiomyopathy represents a diagnosis of exclusion, and prompt identification is crucial as it is a reversible cause of heart failure, and heart function can be recovered after achieving a euthyroid state using antithyroid drugs. Radioactive iodine therapy and surgery are not the best initial therapeutic approach. Moreover, it is important to manage cardiovascular symptoms, for which beta blockers are the first-line therapeutic option.

Association between single nucleotide polymorphisms rs2200733 and rs10033464 at chromosome 4q25 and thyrotoxic atrial fibrillation

Background. Thyrotoxic atrial fibrillation (TAF) genesis does not exclude a genetic component due to the difference in thyroid hormones effects on the cardiovascular system in similar patients. According to genomewide association studies (GWAS), the first locus associated with non-thyrotoxic atrial fibrillation (AF) was locus 4q25, and the first single-nucleotide polymorphisms in it identified as risk factors for AF were polymorphisms rs2200733 and rs10033464. Their connection with TAF remains unclear.Objective. To investigate the possible association of the two single nucleotide polymorphisms rs2200733 and rs10033464 with TAF.Design and methods. The association of TAF and other thyrotoxic cardiomyopathy manifestations with the studied polymorphisms was examined in a sample of 150 patients with Graves’ disease and overt thyrotoxicosis, 18.7 % of whom had TAF. Genotyping was preformed using real time PCR.Results. A significant predominance of TT genotype for both polymorphisms was revealed: p=0.038 for rs10033464, p<0.001 for rs2200733. TT genotype frequency in TAF patients compared with non-TAF participants: 7.4 % vs 1.6 % for rs10033464, 17.9 % vs 0.8 % for rs2200733. When assessing the frequency of genotypes depending on the presence of other thyrotoxic cardiomyopathy manifestations, TT genotype was more common in patients with ventricular premature beats, p=0.001.Conclusion. TT genotype of rs2200733 and rs10033464 polymorphisms at 4q25 locus is associated with a higher incidence of TAF and ventricular extrasystole in thyrotoxic patients.

No evidence of pulmonary hypertension revealed in an echographic evaluation of right-sided hemodynamics in hyperthyroid cats.

Hyperthyroidism is a common endocrinopathy affecting middle-aged to elderly cats, with multisystemic repercussions. Hyperthyroid humans show decreased lung compliance and increased cardiac output with subsequent left heart failure leading to pulmonary capillary congestion. Prognosis worsens with the development of increased pulmonary vascular pressures (ie, pulmonary hypertension [PH]) in hyperthyroid humans. The effect of excess thyroid hormone concentration on pulmonary arterial hemodynamics is unknown in cats. Assessing pulmonary vascular pressures in veterinary medicine relies heavily on echocardiographic measurements performed at the level of the heart and pulmonary trunk. This study investigated right-sided cardiac and pulmonary arterial hemodynamics in hyperthyroid cats using echocardiography. Echocardiographic examinations of hyperthyroid cats identified through a bi-institutional database search were reviewed for the determination of systolic pulmonary arterial pressure (PAP) and 20 other metrics. Values were compared with those of a healthy cat group using non-parametric statistical analyses. Systolic PAP could not be determined in 23/26 hyperthyroid and 13/14 healthy cats owing to unmeasurable tricuspid regurgitation flow velocity. Hyperthyroid cats were roughly twice as old (P <0.001) and had 2-4-fold higher respiratory rates (P <0.001) than healthy cats. Hyperthyroid cats showed an increase in acceleration time-to-ejection time ratio of pulmonary flow (1.4-fold, P = 0.001), pulmonary artery velocity time integral (1.2-1.6-fold, P = 0.001), maximal pulmonary velocity (1.3-1.7-fold, P = 0.002), stroke volume (1.5-fold, P = 0.001) and cardiac output (1.6-fold, P <0.001) vs healthy cats. None of the other echocardiographic metrics reached statistical significance. Systolic PAP estimation proved unsuitable as a sole measurement for the assessment of PH in hyperthyroid cats owing to the frequent inability to interrogate tricuspid regurgitant flow velocity. Hyperthyroid cats have altered echocardiographic measures of pulmonary hemodynamics dissimilar to those reported in hyperthyroid humans. Differential effects of thyrotoxic cardiomyopathy on ventricular systolic function may underlie species differences.

Differentiated search for disease in a patient with hyperthyroisis with a prevailing syndrome of cardiovascular disorders. Clinical case

Background. Elderly patients in the presence of iodine deficiency most often develop functional autonomy of the thyroid gland, accompanied by dysfunction— hyperthyroidism. Due to an excess of thyroid hormones, thyrotoxic cardiomyopathy is formed, in which in most cases there is a syndrome of heart rhythm disturbances— atrial fibrillation. The aim of the study: to find out the algorithm for the differential search for a disease in the presence of hyperthyroidism with severe cardiovascular disorders using the example of a specific elderly patient from real clinical practice. Clinical case. A 61-year-old patient was hospitalized in the intensive care unit for arrhythmogenic shock against the background of an attack of atrial fibrillation. The absence of myocardial infarction, pulmonary embolism, acute adrenal insufficiency was stated. The examination revealed a significant decrease in the level of TSH along with an increase in the levels of thyroid hormones without the phenomena of autoaggression, hyperglycemia, hypocholesterolemia, a tendency to hypoproteinemia, leukopenia. An increase in the thyroid gland, heterogeneity of the structure with hypovascularization, the presence of small multiple nodular formations that require clarification were determined. The patient has atrial fibrillation with variability in blood pressure, impaired repolarization processes, hyperkinetic type of hemodynamics, reflecting cardiomyopathy. In this case, there are all prerequisites for the development of functional autonomy of the thyroid gland: age, endemic region, absence of autoimmune changes, dermopathy, ophthalmopathy. Attention is drawn to the severity of manifestations of thyrotoxic heart with dyshormonal and catabolic syndromes, superimposed on comorbid coronary heart disease, hypertension. Conclusions. Hyperthyroidism in the elderly is manifested primarily by cardiovascular disorders, most often with the presence of an arrhythmia syndrome in the form of atrial fibrillation, which can provoke arrhythmogenic shock. Functional autonomy of the thyroid gland with the formation of thyrotoxic cardiomyopathy has specific clinical course, especially in comorbid conditions, which significantly impairs the quality of life.

Frequency of Hyperthyroidism among Patients with Congestive Heart Failure Presenting at Tertiary Care Hospital, Peshawar

Objective: To determine the frequency of hyperthyroidism among patients with congestive heart failure presenting at tertiary care hospital, Peshawar. Design of the Study: The study design was descriptive cross sectional. Study Settings: The study was conducted at Cardiology Department, Khyber Teaching Hospital, Peshawar from 18 Sept, 2019 to 18 Mar, 2020. Material and Methods: 5cc of venous blood was taken and sent to hospital laboratory for screening of the hyperthyroidism. All the laboratory investigations were carried out by single experience pathologist having minimum of five years of experience. Results of the Study: As per frequencies and percentages for hyperthyroidism, only 08 (4%) patient presented with CHF were recorded with hyperthyroidism Conclusion: In my study I have come to this conclusion that hyperthyroidism can cause high cardiac output and left ventricular hypertrophy, therefore, early and effective treatment of hyperthyroidism is highly recommended in preventing thyrotoxic cardiomyopathy. Keywords: Hyperthyroidism, heart failure, atrial fibrillation, subclinical hyperthyroidism

Серцеві наслідки тяжкого тиреотоксикозу та їх зміни у віддаленому періоді після хірургічного лікування

Актуальність. Результатом хірургічного лікування зоба з тяжким тиреотоксикозом може бути поліпшення загального стану і фізичної активності, зменшення та/або ліквідація клінічних проявів тиреотоксичної кардіоміопатії (ефективне лікування) або ж погіршення загального стану (неефективне лікування). З позицій такого підходу віддалені результати хірургічного лікування токсичного зоба з тяжким тиреотоксикозом вивчені недостатньо. Мета. Вивчити віддалені результати хірургічного лікування хворих на токсичний зоб з тяжким тиреотоксикозом із пріоритетним дослідженням змін серцевої діяльності і фізичної активності. Матеріали та методи. Дослідження проведено у 123 лікованих хірургічним методом хворих на тяжку форму токсичного зоба. Вік пацієнтів становив від 21 до 74 років. Тривалість тиреотоксикозу перебувала в межах від 18 до 74 місяців. Показаннями до хірургічного лікування були часті рецидиви тиреотоксикозу, прогресування тиреотоксичної кардіоміопатії на тлі тиреостатичної терапії з розвитком розладів ритму серцевої діяльності й серцевої недостатності. Вивчали структурні й функціональні зміни в серці за даними ехокардіографії в режимі В, розлади серцевої діяльності за результатами добового холтерівського моніторингу ЕКГ, фізичну активність за даними тесту шестихвилинної ходьби. Віддалені наслідки лікування оцінювали за розробленими градаціями: добрий, задовільний, незадовільний результат і неефективне лікування. Результати. Встановлено, що хірургічне лікування хворих на токсичний зоб з тяжким тиреотоксикозом дозволяє ліквідувати тиреотоксикоз, а в частини пацієнтів — розлади ритму серцевої діяльності, зменшити інтенсивність клінічних проявів тиреотоксичної кардіоміопатії, поліпшити фізичну активність і загальний стан хворих. Проведені дослідження показали, що результати хірургічного лікування залежать від тяжкості розладів ритму серцевої діяльності й серцевої недостатності, тобто наслідків тиреотоксикозу, що розвиваються на основі тиреотоксичної кардіоміопатії. Добрий і задовільний результати хірургічного лікування отримано в 55 (44,7 %) випадках, незадовільний результат — у 40 (32,5 %) хворих, і неефективним лікування було у 28 (22,8 %) пацієнтів. Висновки. Хірургічне лікування хворих на токсичний зоб з тяжким тиреотоксикозом дозволяє досягнути позитивних результатів: ліквідувати тиреотоксикоз, зменшити інтенсивність клінічних проявів тиреотоксичної кардіоміопатії, поліпшити серцеву діяльність, фізичну активність і загальний стан пацієнтів. Віддалені результати хірургічного лікування хворих на тяжкий тиреотоксикоз залежать від тривалості захворювання, медикаментозної терапії тиреотоксикозу і віку пацієнтів. Зі збільшенням значень цих показників результати лікування погіршуються. Серед існуючих показань до хірургічного лікування хворих на токсичний зоб з проявами тяжкого тиреотоксикозу першим і основним є наявність тиреотоксичної кардіоміопатії з розладами ритму серцевої діяльності. Універсальним показником для прогнозування віддалених результатів хірургічного лікування хворих на токсичний зоб є довжина пройденої відстані тесту шестихвилинної ходьби.

Clinical phenotypes and prognosis of thyrotoxic heart failure and cardiomyopathy in patients hospitalized for acute heart failure.

BackgroundWe sought to examine clinical characteristics and outcomes in patients hospitalized for acute heart failure (HF) and thyrotoxicosis.MethodsPatients with thyrotoxic HF were compared with age and gender‐matched patients hospitalized for acute HF (controls). Thyr‐HF was defined by the Framingham criteria for HF and clinical hyperthyroidism. Thyrotoxic cardiomyopathy was defined as left ventricular ejection fraction (LVEF) < 55%.ResultsOf 11 109 consecutive patients hospitalized for acute HF between 1 January 2002 and 1 January 2017, 92 patients (0.8%) had thyrotoxic HF. Clinical and echocardiographic data were available in 87 patients (age 51 ± 16 years; 74% female), representing the study population. Compared with controls, patients with Thyr‐HF had a smaller body surface area (BSA), a higher LVEF, a lower LV end‐diastolic diameter, a higher tricuspid annular plane systolic excursion (TAPSE), higher blood pressure, higher heart rate, and were more likely to have right‐sided HF at presentation (P < 0.01 for all). The survival rate among patients with thyrotoxic HF was higher than the control group (HR: 4.3; 95% CI: 2.1–9.5). Fifty‐eight percent of patients with thyrotoxic HF had thyrotoxic cardiomyopathy. In multivariate analysis, TAPSE (OR = 46; 95% CI: 1.04–2008.20; P = 0.047) and leukocytosis (OR = 16; 95% CI 1.01–259.39; P = 0.049) correlated with thyrotoxic cardiomyopathy. LV recovery was observed in 69% of these patients.ConclusionsThyrotoxic HF was uncommon among patients hospitalized for acute HF. However, after definitive therapy, these patients had a more favourable prognosis than those hospitalized for acute HF without thyrotoxic HF. Clinical phenotypes of thyrotoxic HF include small BSA, middle‐aged female, HF‐pEF, and right‐sided HF. Thyrotoxic cardiomyopathy affected over half of the patients with thyrotoxic HF with a two‐third recovery rate.

The Spread of Thyroid Diseases and the Algorithm for Diagnosing Thyroid Dysfunction

Diseases of the thyroid gland are considered one of the most common endocrinopathies. This is due to the influence of ecologically unfavorable environmental factors, bad habits, malnutrition, comorbid conditions and genetic predisposition. Determining an algorithm for diagnosing thyroid dysfunction for the timely detection of diseases is expedient and relevant. The objective: to analyze the state of the spread of thyroid diseases among the population of the Kiev region and to determine the diagnostic algorithm based on the identification of the main clinical syndromes of thyroid dysfunction. Materials and methods. Among the adult population of the Kiev region, a high level of morbidity and spread of thyroid diseases is recorded. The increase in the number of cases occurred, first of all, due to the newly diagnosed patients with hypothyroidism, thyroiditis. The manifestation of most diseases is associated with the development of thyroid dysfunction. Under the hypothyroidism one can observe and diagnose the following: a syndrome of neuropsychiatric disorders with slowing down of motor activity, decrease in cognitive functions; syndrome of vegetative-trophic disorders with cutaneous mucinosis, polyneuropathy; syndrome of cardiovascular changes with decreased myocardial contractility, slow blood flow, progressive development of atherosclerosis; anemic syndrome; digestive tract syndrome with impaired motor and secretory functions of the gastrointestinal tract; syndrome of hormonal disorders with decreased secretion of thyroid hormones, especially T4, increased levels of TSH (in primary hypothyroidism) or decreased TSH (in secondary and tertiary). Results. Thyrotoxicosis in patients is determined by an enlarged thyroid gland with the development of: thyrotoxic cardiomyopathy and systolic arterial hypertension; thyrotoxic encephalopathy, syndrome of neuropsychiatric disorders with a predominance of excitation processes, vascular dysfunction; thyrotoxic ophthalmopathy, ectodermal disorders syndrome along with a decrease in TSH production and an increase in the level of free fractions T4, T3. Conclusions. The algorithm for diagnosing hypofunction and hyperfunction of the thyroid gland provides for: clarification of complaints and anamnesis data, examination of the patient, additional laboratory and instrumental examination, which includes the study of the thyroid status, possible autoaggression, analysis of metabolic processes, assessment of pathomorphological changes in the thyroid gland.

PERIPARTUM CARDIOMYOPATHY – A CLINICAL CASE

This article presents a clinical case of peripartum cardiomyopathy in a 21-year-oldpatient with a gestational age of 32 weeks, accompanied by clinical manifestationsof heart failure and Lown-Ganong-Levine (LGL) syndrome. The patient underwentlaboratory and instrumental examinations, including echocardiography and Holtermonitoring. Thyrotoxic cardiomyopathy was ruled out in the process of differentialdiagnosis. The final diagnosis and management of the patient were determinedafter consultation with the State Institution "Institute of Pediatrics, Obstetrics andGynecology, named after Academician O.M. Lukyanova, of the National Academy ofMedical Sciences of Ukraine". Medical treatment significantly improved the patient'scondition and vaginal delivery went without complications. Manifestations of theperipartum cardiomyopathy gradually regressed and completely disappeared 6 monthsafter delivery.This case indicates the importance of timely diagnosis of peripartum cardiomyopathyfor a positive prognosis of patients.

Delayed diagnosis of dilated thyrotoxic cardiomyopathy with coexistent multifocal atrial tachycardia: a case report

BackgroundThyroid storm (TS) is a rare but potentially life-threatening sequelae of untreated or undertreated hyperthyroidism. While TS frequently causes high-output heart failure, low-output heart failure related to dilated cardiomyopathy (DCM) is extremely rare. Tachycardia is a common clinical presentation of TS, and β1-selective blockers are the first-line agents for treating TS-associated tachycardia. However, given that β-blockers have negative chronotropic and negative inotropic effects, amiodarone may be safe and effective for the treatment of TS-induced tachyarrhythmia in patients with moderate to severe heart failure. While long-term amiodarone administration causes hypothyroidism, or less frequently, hyperthyroidism, little is known about the effects of short-term amiodarone administration on thyroid function.Case presentationA 31-year-old healthy woman presented with worsening dyspnoea. She was tachycardic with multifocal atrial tachycardia (MAT) of 184 beats/min, confirmed by electrocardiogram. Echocardiographic findings were consistent with DCM, with an ejection fraction of 20%. Thus, she was initially diagnosed with acute heart failure due to DCM with coexistent MAT. Tachycardia persisted despite cardioversion attempts and treatment with multiple anti-arrhythmic drugs. Consequently, she rapidly progressed to cardiogenic shock and respiratory decompensation, which required intubation and an intra-aortic balloon pump support. Moreover, the undiagnosed Graves' disease, lack of suspicion, and postponed analysis of thyroid function tests led to a delayed diagnosis of TS. Amiodarone, which was initiated for MAT, unexpectedly ameliorated thyrotoxicosis, resulting in a euthyroid state and the patient’s significantly improved condition and cardiac function. She was discharged on day 40. Finally, she underwent total thyroidectomy; thyroid pathology was consisting with Graves' disease. Her postoperative course was uneventful.ConclusionsHerein, we describe a case of delayed diagnosis of dilated thyrotoxic cardiomyopathy with coexistent MAT. The patient required intensive care due to the catastrophic sequelae and was successfully treated with amiodarone. This is the first case report of TS-associated MAT and highlights the clinical importance of high suspicion of TS in de novo heart failure with any tachyarrhythmia or DCM of unknown etiology and the potential effects of short-term amiodarone administration in the treatment of TS.

Sick sinus syndrome and hyperthyroidism: A rare phenomenon

Cardiovascular complications play a very crucial part in hyperthyroidism and increased mortality and morbidity risk. Besides tachyarrhythmia, impaired systolic ventricular dysfunction and diastolic dysfunction may cause thyrotoxic cardiomyopathy in a small percentage of the patients, as another high mortality complication. Bradycardia in hyperthyroidism is a rare phenomenon which is associated with the sinus node dysfunction, atrioventricular node dysfunction, and conduction disturbance, or due to the effect of the drugs, i.e. beta-blockers. A 70-year-old female patient was brought to the emergency department with the history of feeling dizziness, lightheadedness, and bradycardia. While waiting in emergency, she had an episode of syncope, followed by regain of consciousness after 20 min. The patient was shifted for pacemaker insertion. Furthermore, hyperthyroidism and sick sinus syndrome are rare phenomena; it is highlighted mainly among patients with Graves' disease.

Thyrotoxic dilated cardiomyopathy: personal experience and case collection from the literature.

SummaryThe authors examine several reports of the literature concerning thyrotoxic dilated cardiomyopathy. In particular, it is pointed out that this clinical manifestation of hyperthyroidism is rare in readily diagnosed and properly treated hyperthyroidism. Case reports are analyzed comparatively. A case deriving from the direct experience of the authors is also presented.Learning points:Dilated cardiomyopathy has been reported as the initial presentation of hyperthyroidism in only 6% of patients although <1% developed severe LV dysfunction.Clinical picture of thyrotoxic dilated cardiomyopathy can degenerate into an overt cardiogenic shock sometimes requiring the use of devices for mechanical assistance to the circulation, or extracorporeal membrane oxygenation.For thyrotoxic dilated cardiomyopathy, evidence-based pharmacologic measures valid for heart failure should always be supplemented by the administration of specific thyroid therapies such as thionamides (methimazole, carbimazole or propylthiouracil), whose relatively long latency of action should be supported by the i.v. administration of small doses of beta-blocker.In cases of cardiogenic shock, the administration of beta-blocker should be carried out only after the restoration of satisfactory blood pressure levels- with the prudent use of synthetic catecholamines, if necessary.

Apathetic Thyroid Storm with Cardiorespiratory Failure, Pulmonary Embolism, and Coagulopathy in a Young Male with Graves’ Disease and Myopathy

A 38-year-old gentleman presented with thyroid storm with multiorgan involvement in the form of heart failure (thyrotoxic cardiomyopathy), respiratory failure (respiratory muscle fatigue), hepatic dysfunction, fast atrial fibrillation, pulmonary embolism, and disseminated intravascular coagulation (DIC). His Graves' disease (GD) remained undiagnosed for nearly 8 months because apart from weight loss, he has not had any other symptoms of thyrotoxicosis. The presentation of thyroid storm was atypical (apathetic thyroid storm) with features of depression and extreme lethargy without any fever, anxiety, agitation, or seizure. There were no identifiable triggers for the thyroid storm. Apart from mechanical ventilation and continuous veno-venous renal replacement therapy in the intensive care unit, he received propylthiouracil (PTU), esmolol, and corticosteroids, which were later switched to carbimazole and propranolol with steroids being tapered down. He was diagnosed with thyrotoxic myopathy which, like GD, remained undiagnosed for long (fatigability). A high index of suspicion and a multidisciplinary care are essential for good outcome in these patients.