ID: 17: GRAVES DISEASE INDUCED DILATED CARDIOMYOPATHY

2016 ◽  
Vol 64 (4) ◽  
pp. 924.2-925
Author(s):  
H Alkhawam ◽  
N Vyas ◽  
R Sogomonian ◽  
A Al-khazraji ◽  
M Kabach
Keyword(s):  
Atrial Fibrillation ◽  
Dilated Cardiomyopathy ◽  
Systolic Function ◽  
Lower Extremities ◽  
Left Ventricular ◽  
Exercise Intolerance ◽  
Graves Disease ◽  
Metabolic Demand ◽  
Free T4 ◽  
Severe Left Ventricular Dysfunction

IntroductionGraves' thyrotoxicosis has many cardiovascular complications; however, the most cardiac complication is atrial fibrillation but rarely causes heart failure. Less than 1% develops dilated cardiomyopathy with impaired left ventricular systolic function. In this case report we describe a case of Graves' hyperthyroidism-induced reversible cardiomyopathy.Case presentation45 year old female with a history of previously treated Graves' disease who presented to hospital for altered mental status and severe hypoglycemia. The hospital course complicated by Atrial fibrillation with RVR. Patient states that recently started feeling fatigue, orthopnea, decrease exercise intolerance, lower extremities edema and distended abdomen. In emergency department, patient found to have hypotension and tachycardic. She was given IV fluids but her blood pressure didn't respond. Patient was started on Levophed for hypotension. Physical examination demonstrated impressive proptosis, positive jugular venous distension, irregular irregularity of her plus and +2 lower extremities edema .Patient found to have Graves storm (TSH: 0.07 uIU/ml, Free T4: 1.89 ng/dL, T3: 36.6 ng/dL, cortisol level: 59.36 Ug/dL). She was started on methimazole, steroids and lugols iodine drops. Hypoglycemia that she had most likely was related to lack of glycogen stores and increased metabolic demand with graces. After the patient stabilized, echocardiogram obtained which showed severe left ventricular dysfunction (LVEF 30%), bi-atrial dilatation, LV dilated, moderate MR and TR. So, patient was transferred to CCU for acute dilated cardiomyopathy secondary to graves storm. She was started on Lasix 40 mg IV then switched to 20 mg PO twice a day, Metoprolol 25 mg twice a day and Digoxin 0.125 mg daily and Apixaban 5 mg twice daily. Ophthalmology consulted for proptosis who recommended artificial tears, ocular lubricant and decompression.Abstract ID: 17 Figure 1

scholarly journals Amiodarone-induced thyrotoxicosis: left ventricular dysfunction is associated with increased mortality

2006 ◽  
Vol 154 (4) ◽  
pp. 533-536 ◽  
Author(s):  
Anthony J O’Sullivan ◽  
Mridula Lewis ◽  
Terrance Diamond
Keyword(s):  
Left Ventricular Dysfunction ◽  
Ventricular Dysfunction ◽  
Treated Group ◽  
Left Ventricular ◽  
Graves Disease ◽  
Management Problem ◽  
Free Triiodothyronine ◽  
Free T4 ◽  
Severe Left Ventricular Dysfunction ◽  
Significant Difference

Objective: Amiodarone-induced thyrotoxicosis (AIT) is a challenging management problem, since patients treated with amiodarone invariably have underlying heart disease. Consequently, thyrotoxicosis can significantly contribute to increased morbidity and mortality. The aim of this study was to compare the clinical outcome and hormone profiles of patients with AIT (n = 60) with those with Graves’ thyrotoxicosis (n = 49) and toxic multinodular goitre (MNG, n = 40). Design: A retrospective study of patients with AIT in a single institution was conducted. Methods: Data from patients with AIT over 12 years were collected. Results: Mean TSH levels were significantly suppressed in all three groups. However, there was no intergroup significant difference. Free thyroxine (T4) levels were significantly higher in AIT (45.6 ± 3.5 pmol/l) and Graves’ disease (44.6 ± 4.0 pmol/l) compared with toxic MNG (31.5 ± 5.1 pmol/l, P < 0.05). In contrast, free triiodothyronine (T3) levels were only significantly higher in Graves’ disease (14.7 ± 1.5 pmol/l, P = 0.002) compared with AIT (8.6 ± 0.7 pmol/l) and toxic MNG (7.4 ± 0.5 pmol/l). Six deaths occurred in the patients with AIT (10.0%, P < 0.01) and no deaths occurred in the other groups. Amiodarone treatment (P = 0.002) was the most significant predictor of death, whereas free T4, free T3 and age did not affect outcome. Within the amiodarone-treated group severe left ventricular dysfunction (P = 0.0001) was significantly associated with death. Conclusions: (i) AIT differs from other forms of thyrotoxicosis, and (ii) severe left ventricular dysfunction is associated with increased mortality in AIT.

scholarly journals Focus on Autoimmune Myocarditis in Graves' Disease: A Case-Based Review

2021 ◽  
Vol 8 ◽  
Author(s):  
Lujin Wu ◽  
Wei Wang ◽  
Qianru Leng ◽  
Nana Tang ◽  
Ning Zhou ◽  
...  
Keyword(s):  
Dilated Cardiomyopathy ◽  
Troponin I ◽  
Systolic Function ◽  
Acute Myocarditis ◽  
T2 Mapping ◽  
Myocardial Necrosis ◽  
Left Ventricular ◽  
Diagnosis And Treatment ◽  
Graves Disease ◽  
Autoimmune Myocarditis

The manifestations of hyperthyroidism-related myocardial damage are multitudinous, including arrhythmia, dilated cardiomyopathy, valvular diseases, and even cardiogenic shock. Acute myocarditis induced by thyrotoxicosis had been reported in a few studies. However, attention on its prevalence and underlying mechanisms is sorely lacking. Its long-term harm is often ignored, and it may eventually develop into dilated cardiomyopathy and heart failure. We report a case of Graves' disease with a progressive elevation of hypersensitive cardiac troponin-I at several days after discontinuation of the patient's anti-thyroid drugs. Cardiac magnetic resonance imaging (CMRI) showed inflammatory edema of some cardiomyocytes (stranded enhanced signals under T2 mapping), myocardial necrosis (scattered enhanced signals under T1 late gadolinium enhancement) in the medial and inferior epicardial wall, with a decreased left ventricular systolic function (48%), which implied a possibility of acute myocarditis induced by thyrotoxicosis. The patient was then given a transient glucocorticoid (GC) treatment and achieved a good curative effect. Inspired by this case, we aim to systematically elaborate the pathogenesis, diagnosis, and treatment of hyperthyroidism-induced autoimmune myocarditis. Additionally, we emphasize the importance of CMRI and GC therapy in the diagnosis and treatment of hyperthyroidism-related myocarditis.

scholarly journals Double trouble – thyro-pericarditis: rare presentation of Graves’ disease as pericarditis—a case report

2020 ◽  
Author(s):  
Mohsin Gondal ◽  
Ali Hussain ◽  
Hira Yousuf ◽  
Zahra Haider
Keyword(s):  
Clinical Examination ◽  
Systolic Function ◽  
Beta Blockers ◽  
Case Reports ◽  
Left Ventricular ◽  
Graves Disease ◽  
Thyroid Function Tests ◽  
Free T4 ◽  
Rare Presentation ◽  
Acute Pericarditis

Abstract Background Acute pericarditis is frequently encountered in clinical practice; however, pericarditis as the first presentation of Graves' disease is rare and mainly limited to case reports in the literature. We hereby report a case in which a young patient presented with pericarditis as the first manifestation of Graves’ disease. Case summary A 24-year-old male was admitted to hospital with presenting complaint of left-sided chest pain, gradual in onset, 6/10 in intensity, sharp in character, increased by deep breathing and improved by leaning forward. Patient also gave a history of insomnia, unintentional weight loss despite a good appetite, heat intolerance, and anxiety. On clinical examination, the patient had features of thyrotoxicosis, i.e., tachycardia, high volume pulse, and sweaty palms with fine tremors. There was no associated pericardial rub. Neck examination shows diffuse, non-tender goitre. Electrocardiogram findings were consistent with acute pericarditis. His thyroid function tests demonstrated hyperthyroidism and anti-thyroglobulin antibodies were also significantly elevated. Echocardiogram showed preserved left ventricular systolic function and a small global pericardial effusion without any signs of tamponade. He was diagnosed with Graves’ disease revealing itself as pericarditis and was started on ibuprofen, beta-blockers, and carbimazole. Patient had marked clinical and biochemical improvement on 3 monthly follow-ups. Discussion Thyro-pericarditis is a rare entity, and limited literature is available regarding this combination. The exact aetiology of Graves associated pericarditis is unknown. There is a possibility of interaction of autoantibodies with receptors on pericardium. Diagnosis is based on a detailed history, clinical examination, supplemented by relevant investigations (elevated free T4 and thyroid receptor antibodies, suppressed thyroid stimulating hormone (TSH) and Imaging via ultrasound). Mainstay of treatment includes non-steroidal anti-inflammatory drugs, beta-blockers, and anti-thyroidal medications.

scholarly journals Strain parameters for predicting the prognosis of non‐ischemic dilated cardiomyopathy using cardiovascular magnetic resonance tissue feature tracking

2021 ◽  
Vol 23 (1) ◽  
Author(s):  
Chengjie Gao ◽  
Yajie Gao ◽  
Jingyu Hang ◽  
Meng Wei ◽  
Jingbo Li ◽  
...  
Keyword(s):  
Cardiovascular Magnetic Resonance ◽  
Magnetic Resonance ◽  
Dilated Cardiomyopathy ◽  
Feature Tracking ◽  
Systolic Function ◽  
Radial Strain ◽  
Left Ventricular ◽  
Multivariate Logistic Regression Model ◽  
Non Ischemic Dilated Cardiomyopathy

Abstract Background A considerable number of non-ischemic dilated cardiomyopathy (NDCM) patients had been found to have normalized left ventricular (LV) size and systolic function with tailored medical treatments. Accordingly, we aimed to evaluate if strain parameters assessed by cardiovascular magnetic resonance (CMR) feature tracking (FT) analysis could predict the NDCM recovery. Methods 79 newly diagnosed NDCM patients who underwent baseline and follow-up CMR scans were enrolled. Recovery was defined as a current normalized LV size and systolic function evaluated by CMR. Results Among 79 patients, 21 (27%) were confirmed recovered at a median follow-up of 36 months. Recovered patients presented with faster heart rates (HR) and larger body surface area (BSA) at baseline (P < 0.05). Compared to unrecovered patients, recovered pateints had a higher LV apical radial strain divided by basal radial strain (RSapi/bas) and a lower standard deviation of time to peak radial strain in 16 segments of the LV (SD16-TTPRS). According to a multivariate logistic regression model, RSapi/bas (P = 0.035) and SD16-TTPRS (P = 0.012) resulted as significant predictors for differentiation of recovered from unrecovered patients. The sensitivity and specificity of RSapi/bas and SD16-TTPRS for predicting recovered conditions were 76%, 67%, and 91%, 59%, with the area under the curve of 0.75 and 0.76, respectively. Further, Kaplan Meier survival analysis showed that patients with RSapi/bas ≥ 0.95% and SD16-FTPRS ≤ 111 ms had the highest recovery rate (65%, P = 0.027). Conclusions RSapi/bas and CMR SD16-TTPRS may be used as non-invasive parameters for predicting LV recovery in NDCM. This finding may be beneficial for subsequent treatments and prognosis of NDCM patients. Registration number: ChiCTR-POC-17012586.

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