A Case Report of Dilated Biventricular Heart Failure from Hyperthyroidism: A Rare Presentation

Abstract

Hyperthyroidism is a common metabolic disorder with many cardiovascular manifestations. In rare cases, untreated hyperthyroidism can lead to thyrotoxic cardiomyopathy with severe left ventricular (LV) dysfunction. This case report aims to discuss the pathogenesis of heart failure in hyperthyroidism and the available treatment options.A 51-year-old male with a past history of untreated hyperthyroidism presented to our hospital for the evaluation of shortness of breath and dysphagia. Workup revealed atrial flutter and severe biventricular dilated cardiomyopathy. Stabilization thyroidectomy was performed due to dysphagia, and treatment with oral antithyroid medications was initiated. The patient was discharged on synthroid and beta-blockers.Untreated hyperthyroidism can lead to biventricular failure even in the young. Untreated hyperthyroidism leads to significant mortality and morbidity. Untreated hyperthyroidism is associated with atrial fibrillation, heart failure, pulmonary hypertension (PH), and angina-like symptoms. Further studies should be done to evaluate the pathogenesis of Graves/Goiter hyperthyroidism and the least-invasive, safe, and definitive treatment options should be discovered. Current treatment options are limited and include medication that needs to be taken lifelong; they are associated with toxicity. Radioactive iodine ablation comes with the drawback of long-term replacement therapy. The last option is surgery, which is invasive and has its own complications.

Thyrotoxic Cardiomyopathy: State of the Art

“…The goal of the treatment in patients with TCM is to restore euthyroidism and to manage cardiovascular manifestations using oral antithyroid drugs. 47 The achievement of permanent euthyroid status is of great importance as it is associated with a better prognosis and improves cardiovascular parameters, such as heart rate, number of extrasystoles and cardiac output. 7 …”

“…The goal of the treatment in patients with TCM is to restore euthyroidism and to manage cardiovascular manifestations using oral antithyroid drugs. 47 The achievement of permanent euthyroid status is of great importance as it is associated with a better prognosis and improves cardiovascular parameters, such as heart rate, number of extrasystoles and cardiac output. 7 Treating TCM using surgery or radioactive iodine instead of antithyroid drugs is not easy, 26 as surgical treatment is associated with high perioperative and intraoperative risk and radioactive iodine therapy is associated with worse prognosis.…”