A case of hypothyroidism mimicking acute coronary syndrome

Area of Science:

• Cardiology
• Endocrinology
• Biochemistry

Background:

• Hypothyroidism can elevate creatine kinase (CK) levels, primarily CK-MM.
• Elevated CK-MB in hypothyroid patients without myocardial damage can mimic cardiac injury.
• Troponin I is a preferred marker for myocardial infarction (MI) in hypothyroid individuals.

Observation:

• This report details a 47-year-old male hypothyroid patient presenting with chest pain.
• The patient exhibited abnormal ECG findings and elevated cardiac enzymes, suggestive of acute coronary syndrome.
• Coronary arteriogram revealed no significant coronary artery disease.

Findings:

• The case demonstrates that troponin I can be elevated in hypothyroid patients even without myocardial damage.
• This finding challenges the exclusive reliance on troponin I for diagnosing MI in this patient population.
• The observed elevation in cardiac enzymes was not attributable to acute coronary syndrome.

Implications:

• Accurate diagnosis of myocardial injury in hypothyroid patients requires careful consideration of thyroid status.
• Relying solely on cardiac biomarkers like troponin I may lead to misdiagnosis in hypothyroid patients.
• Further research is needed to understand the mechanisms behind elevated cardiac biomarkers in hypothyroidism.