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Chest pain, enzymes and hypothyroidism
S R Strachan1, O Afolabi, N Brown
1Cardiology Department, Queen's Medical Centre, University Hospital, Clifton Boulevard, Nottingham, NG7 2UH, UK.
Insights
Severe hypothyroidism can mimic a heart attack, presenting with elevated creatine kinase and ECG changes. Prompt thyroxine treatment resolved these cardiac-like symptoms, highlighting a crucial differential diagnosis.
Area of Science:
- Endocrinology
- Cardiology
- Internal Medicine
Background:
- Hypothyroidism is a common endocrine disorder with diverse clinical presentations.
- Classical symptoms are often straightforward, but atypical presentations can occur.
- Misdiagnosis is possible when symptoms overlap with other conditions.
Observation:
- A case of severe hypothyroidism presented with symptoms mimicking acute myocardial infarction.
- The patient exhibited elevated creatine kinase levels and electrocardiographic abnormalities.
- These findings are typically associated with cardiac events.
Findings:
- Thyroid hormone replacement therapy with thyroxine led to the resolution of cardiac-like symptoms.
- The electrocardiographic abnormalities normalized post-treatment.
- Creatine kinase levels returned to normal ranges after thyroxine administration.
Implications:
- Severe hypothyroidism should be considered in the differential diagnosis of cardiac events, especially with unexplained creatine kinase elevation and ECG changes.
- Early recognition and treatment of hypothyroidism can prevent unnecessary cardiac interventions.
- This case underscores the importance of a comprehensive diagnostic approach in complex clinical scenarios.
Abstract:
Hypothyroidism is a common disorder and when presenting with classical symptoms and signs is easy to recognise. However, hypothyroidism may present in a manner suggestive of an acute myocardial infarction with an elevated creatine kinase and electrocardiographic abnormalities. We report a case of severe hypothyroidism presenting as a cardiac event whose symptoms and signs dispersed following treatment with thyroxine.