Thyrotoxicosis-Induced Cardiomyopathy Complicated by Refractory Cardiogenic Shock Rescued by Extracorporeal Membrane Oxygenation

Abstract

Patient: Male 53-year-old Final Diagnosis: Thyrotoxicosis-induced cardiomyopathy Symptoms: Dyspnea Medication:— Clinical Procedure: — Specialty: Cardiology • Critical Care Medicine Objective: Unusual clinical course Background: Thyrotoxicosis-induced cardiomyopathy is a rare but potentially life-threatening condition that occurs in less than 1% of thyrotoxic individuals. Severely impaired left ventricular systolic function can lead to an overt cardiogenic shock requiring mechanical circulatory support. Abnormal cardiac structure and function are potentially reversible after achievement of euthyroid state. Case Report: We present a case of a 53-year-old patient with a diagnosis of thyrotoxicosis-induced acute heart failure. Transthoracic echocardiography revealed a mildly dilated left ventricle and severely reduced systolic function with ejection fraction of 20%. Subsequently, the patient developed refractory cardiogenic shock, which was treated with the use of extracorporeal membrane oxygenation (ECMO). After early intensive treatments to achieve euthyroid state, the clinical status significantly improved. Echocardiography prior to discharge showed improvement of left ventricular ejection fraction to 40%. The anti-TSH receptor was positive and Grave’s disease was diagnosed. The patient eventually returned to baseline functional status and could return to basic activities of daily living without limitations. Conclusions: Early diagnosis of cardiac involvement in patients with thyrotoxicosis is critical. Promptly delivered intensive treatment with rapid achievement of euthyroid state can reverse cardiac dysfunction and improve patient outcomes. The use of ECMO can be considered as a “bridge” to recovery of cardiac function after restoration of euthyroid state.

Thyrotoxic Cardiomyopathy Unveiled: Insights From a Compelling Case Report

“…In cases of poorly controlled thyroid function, dilated cardiomyopathy typically starts with left ventricular hypertrophy and high cardiac output. However, as the disease progresses, biventricular dilatation and congestive HF with reduced ejection fraction become more common, as documented in the literature [5,[7][8][9][10][11][12].…”

“…Among the numerous articles that have explored TCM in the literature [5,[7][8][9][10][11], this study, to the best of our knowledge, is one of the very few case reports of TCM presenting as heart failure with preserved ejection fraction (HFpEF) and only atrial involvement. Our findings provide a unique perspective that will advance the understanding of this rare condition and could lead to improved diagnosis and treatment for these patients.…”

Thyrotoxicosis-Induced Cardiomyopathy With Systolic Dysfunction

“…Taken together, this creates a hyperdynamic circulatory state [ 20 , 21 ]. While thyrotoxicosis has commonly been shown to contribute to the signs and symptoms of CHF [ 19 , 22 ], it has rarely been associated with the development of left ventricular systolic dysfunction [ 15 , 23 , 24 ]. Hyperthyroidism is a very rare (<1%) cause of dilated cardiomyopathy [ 25 ].…”

“…Dahl et al found that although 6% of thyrotoxic individuals developed symptoms of heart failure, less than 1% developed dilated cardiomyopathy with impaired left ventricular systolic function [ 16 ]. Additionally, case reports on the development of dilated cardiomyopathy with reduced ejection fraction (EF) secondary to thyrotoxicosis have been in middle-aged or elderly patients [ 14 , 15 ]. We present a novel case of a young patient who presented with thyrotoxicosis and subsequently developed dilated cardiomyopathy with reduced ejection fraction and global hypokinesis.…”

“…There is a vast amount of literature on the relationship between thyrotoxicosis as well as hyperthyroidism and high-output heart failure and left ventricular hypertrophy [7][8][9][10][11][12][13]. However, there has been a paucity of articles discussing the development of severe left ventricular dysfunction in a patient with acute thyrotoxicosis [14,15]. Dahl et al found that although 6% of thyrotoxic individuals developed symptoms of heart failure, less than 1% developed dilated cardiomyopathy with impaired left ventricular systolic function [16].…”