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Case Reports
. 2024 May 24;103(21):e38305.
doi: 10.1097/MD.0000000000038305.

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

Rui Shi  1 , Wenyi Meng  2 , Jinzhu Yin  1 , Wen Xue  1 , Yue Deng  1   3
Affiliations
Case Reports

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

Rui Shi et al. Medicine (Baltimore). .

Abstract

Rationale: 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.

Patient concerns: 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).

Diagnoses: After a comprehensive evaluation, the patient was diagnosed with thyrotoxic cardiomyopathy, acute heart failure, and atrial fibrillation with preexcitation syndrome.

Interventions: 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.

Outcomes: 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.

Lessons: 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.

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Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Figure 1.
Figure 1.
Electrocardiogram at first visit. Rapid-type atrial fibrillation, type A preexcitation syndrome, ST-segment downshift, T-wave inversion in some leads.
Figure 2.
Figure 2.
Echocardiograms from the first visit to the last follow-up. (A) Apical 4-chamber view at first visit; (B) Left ventricular long-axis view at first visit; (C) Indices of echocardiogram at the first visit. (D) Apical 4-chamber view at 1-mo follow-up. (E) Left ventricular long-axis view at 1-mo follow-up. (F) Indices of echocardiogram at 1-mo follow-up.
Figure 3.
Figure 3.
Comparison of thyroid ultrasound between the first visit and the last follow-up. (A) Thyroid ultrasound findings at the first visit. (B) Thyroid ultrasound findings at follow-up.
Figure 4.
Figure 4.
Electrocardiogram at the last follow-up. Sinus rhythm, normal ECG.
Figure 5.
Figure 5.
Changes in indicators during treatment and at follow-up. FT3 = free triiodothyronine, FT4: free thyroxine, HR = heart rate, LVEF = left ventricular ejection fraction, LVIDd = left ventricular internal dimension in diastole, Ntpro-BNP = N-terminal pro-b-type natriuretic peptide.
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