Cardiogenic shock in a patient with hypothyroid myopathy responsive only to thyroxin replacement: a case report

Dharmasena, Sanath; Burzyantseva, Olga; Jayawardana, Suriya; Rupanagudy, Vijay A; Pathmanathan, Krishnan

doi:10.1186/1757-1626-3-66

Cited by 7 publications

(7 citation statements)

References 7 publications

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“…Cardiogenic shock, when present in a patient with hypothyroidism, demonstrates poor response to catecholamines. Severe hypothyroidism results in muscle and isovolemic relaxation, increased contraction times, and an increase in the myocardial performance index of systolic and diastolic function ( 4 ). Sinus bradycardia, low QRS voltage, prolonged QT interval, low P-wave amplitude, right branch blockage, ventricular dysrhythmia, and torsades de pointes may be seen on electrocardiography (ECG) in hypothyroidism ( 2 , 3 , 4 , 5 ).…”

Section: Introductionmentioning

confidence: 99%

Cardiac Function in Newborns with Congenital Hypothyroidism: Association with Thyroid-Stimulating Hormone Levels

Öner¹,

Özdemir²,

Doksöz³

et al. 2015

Jcrpe

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Objective:The aims of this study were to demonstrate ventricular function changes in patients with congenital hypothyroidism and to investigate whether there is an association between any such changes and thyroid-stimulating hormone (TSH) levels using M-mode and Doppler electrocardiography (ECG) and tissue Doppler imaging (TDI).Methods:Twenty-seven patients 5-30 days of age with congenital hypothyroidism who were scheduled to receive L-thyroxine treatment and 20 healthy newborns were included in this study. Twelve-lead ECG and M-mode TDI recordings of the patient and healthy groups were obtained. The patient group was divided into two subgroups according to TSH level (>100 uIU/mL or <100 uIU/mL), which were then compared on all parameters.Results:Decreases were observed in the ejection fraction (EF), shortening fraction (SF), and mitral lateral annulus, mitral septal annulus, and tricuspid lateral annulus systolic velocity (Sa) on TDI, whereas left ventricular end-systolic diameter (LVESd) and corrected QT interval (QTc) dispersion were significantly increased in the patient group compared with the control group. No significant differences between the groups were found in left ventricular end-diastolic diameter (LVEDd) or heart rate. When the two patient subgroups (TSH >100 uIU/mL and <100 uIU/mL) were compared, TDI septal annulus Sa wave length and heart rate were significantly lower in the TSH >100 group.Conclusion:Impairment in left ventricular systolic function and increased risk of arrhythmia were observed in newborn infants with congenital hypothyroidism. TSH level was associated with heart rate and interventricular septum velocity.

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Section: Introductionmentioning

confidence: 99%

Cardiac Function in Newborns with Congenital Hypothyroidism: Association with Thyroid-Stimulating Hormone Levels

Öner¹,

Özdemir²,

Doksöz³

et al. 2015

Jcrpe

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“…While cardiac dysfunction is well documented secondary to hypothyroidism, hypotension and cardiogenic shock is rare and is resistant to conventional therapy in the form of intravenous fluids and vasopressors. [57] In such cases, urgent levothyroxine replacement can restore hemodynamic stability by reversing the systolic and diastolic dysfunction, as seen in our case. Similar cases have been described in adults.…”

Section: Discussionmentioning

confidence: 65%

“…Severe hypothyroidism causes muscle relaxation and the isovolumetric relaxation and contraction time becomes prolonged and myocardial performance index (MPI) increases indicating systolic and diastolic dysfunction. [5] The ECG changes seen in hypothyroidism include sinus bradycardia, low voltage QRS complexes, prolonged QT interval, low P wave amplitude, right bundle branch block and ventricular dysrhythmias, including torsades de pointes. [3–6] These cardiovascular effects are usually reversed after starting thyroxin.…”

Section: Discussionmentioning

confidence: 99%

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Refractory cardiogenic shock in an infant with congenital hypothyroidism

Zaki¹,

Dolas²

2012

Indian Journal of Critical Care Medicine

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Thyroid dysfunction causes remarkable cardiovascular derangements. Both systolic and diastolic dysfunction of the heart can occur in hypothyroidism leading to cardiac arrhythmia and congestive heart failure. Refractory cardiogenic shock and hypotension in congenital hypothyroidism is rare. We describe a 5-month-old female infant with congenital hypothyroidism and refractory cardiogenic shock. Cardiac function and hemodynamic stability were restored after starting levothyroxine therapy.

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“…Reduced availability of intracellular calcium results in a dysfunctional systole and diastole, leading to poor contractility and ventricular filling [11]. Other possible hemodynamic changes include an increased systemic vascular resistance, pericardial effusion, endothelial dysfunction, impaired relaxation and increased ventricular filling time, ventricular asynchrony, QT prolongation with risk of Torsades de Pointes, heart failure, and cardiogenic shock [13,[16][17][18]. The development of overt heart failure is rare, however, owing to decreased oxygen consumption in cardiac myocytes during the hypothyroid state [14].…”

Section: Discussionmentioning

confidence: 99%

Differential reversibility in heart failure due to hypothyroidism: A series of contrasting cases with review of literature

Roberto¹,

Aung²,

Agarwal³

et al. 2016

IJCRI

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International Journal of Case Reports and Images (IJCRI) is an international, peer reviewed, monthly, open access, online journal, publishing high-quality, articles in all areas of basic medical sciences and clinical specialties.Aim of IJCRI is to encourage the publication of new information by providing a platform for reporting of unique, unusual and rare cases which enhance understanding of disease process, its diagnosis, management and clinico-pathologic correlations.IJCRI publishes Review Articles, Case Series, Case Reports, Case in Images, Clinical Images and Letters to Editor. Website: www.ijcasereportsandimages.comDifferential reversibility in heart failure due to hypothyroidism:A series of contrasting cases with review of literature E. Samuel Roberto, Thein Aung, Ajay Agarwal, Roberto J. Colón ABSTRACT Introduction: Ranking third as a leading cause of heart failure in the United States, dilated cardiomyopathy (DCMP) affects 5 in 100,00 adults with an eight-year mortality rate between 70-80%. In the setting of hypothyroidism, DCMP is unique due to its potential reversibility with medical therapy. Thyroid hormone affects cardiac physiology and intracellular calcium regulation via SERCA2 and phospholamban, with concentrations of phospholamban most numerous in the ventricles. Administration of thyroid hormone can restore contractile function. However, the relationship between disease timeline and reversibility in DCMP due to hypothyroidism has not been previously described. Case Series: A 65-year-old Caucasian male presented with new onset severe dyspnea and fatigue. Thyroid-stimulating hormone was markedly elevated. Following levothyroxine therapy, his dilated cardiomyopathy reversed and returned to normal within six months. LVEF improved from 15-45% with decreased chamber dilation. A 60-year-old Caucasian female presented minimally responsive in overt heart failure due to myxedema coma. History revealed chronically uncontrolled hypothyroidism. TSH was significantly elevated. Following prolonged hospitalization and intravenous levothyroxine therapy, her clinical status began to reverse. LVEF improved from 10-25%, with decreased chamber dilation. Conclusion:Once the underlying mechanism of heart failure was addressed, the cases displayed varying recovery of contractility following thyroid hormone replacement. This may suggest that with longer duration of uncontrolled disease and consequent cardiac structural remodeling, the reversibility diminishes into irreversibility. These cases underscore the need to identify and treat early any contributing hypothyroidism in the setting of new onset dilated cardiomyopathy, as reversibility may be at stake.

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Cardiogenic shock in a patient with hypothyroid myopathy responsive only to thyroxin replacement: a case report

Cited by 7 publications

References 7 publications

Cardiac Function in Newborns with Congenital Hypothyroidism: Association with Thyroid-Stimulating Hormone Levels

Cardiac Function in Newborns with Congenital Hypothyroidism: Association with Thyroid-Stimulating Hormone Levels

Refractory cardiogenic shock in an infant with congenital hypothyroidism

Differential reversibility in heart failure due to hypothyroidism: A series of contrasting cases with review of literature

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