Acute Myocardial Infarction Following Hormone Replacement in Hypothyroidism

Oe, Kotaro; Yamagata, Toshio; Mori, Kiyoo

doi:10.1536/ihj.48.107

Cited by 4 publications

(1 citation statement)

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“…Cardiac Ischemia related to hyperthyroidism is rarely described in the literature and is the topic of older publications and a limited number of case reports [ 6 – 12 ]. It has been particularly described in elderly patients with coronary artery disease [ 22 ]. The mechanisms explaining cardiac ischemia in patients with hyperthyroidism remain unclear, but they might involve an increased myocardial oxygen demand related to cardiac hypertrophy, temporary coronary artery occlusion in a procoagulant state and vasoconstriction / vasospasm.…”

Section: Discussionmentioning

confidence: 99%

Cardiac evaluation in amiodarone-induced thyroid dysfunction with suspected cardiac ischemia?: a case report and review of the literature

Aubry,

Dosch,

Donath

2024

J Med Case Reports

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Background Amiodarone-induced thyroid dysfunction (AIT) is a side-effect associated with the use of Amiodarone for the treatment of refractory arrythmias. Resulting hyperthyroidism can precipitate cardiac complications, including cardiac ischemia and myocardial infarction, although this has only been described in a few case reports. Case presentation We present here a clinical scenario involving a 66-year-old male Caucasian patient under Amiodarone for atrial fibrillation, who developed AIT. In the presence of dyspnea, multiple cardiovascular risk factors and ECG abnormalities, a transthoracic echocardiogram was performed, showing inferobasal hypokinesia. This led to further investigations through a cardiac PET-CT, where cardiac ischemia was suspected. Ultimately, the coronary angiography revealed no abnormalities. Nonetheless, these extensive cardiologic investigations led to a delay in initiating an emergency endovascular revascularization for acute-on-chronic left limb ischemia. Although initial treatment using Carbimazole was not successful after three weeks, the patient reached euthyroidism after completion of the treatment with Prednisone so that eventually thyroidectomy was not performed. Endovascular revascularization was finally performed after more than one month. Conclusions We discuss here cardiac abnormalities in patients with AIT, which may be due to relative ischemia secondary to increased metabolic demand during hyperthyroidism. Improvement of cardiac complications is expected through an optimal AIT therapy including medical therapy as the primary approach and, when necessary, thyroidectomy. Cardiac investigations in the context of AIT should be carefully considered and may not justify delaying other crucial interventions. If considered mandatory, diagnostic procedures such as coronary angiography should be preferred to functional testing.

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Section: Discussionmentioning

confidence: 99%