[Hypocalcemic cardiomyopathy secondary to hypoparathyroidism after a thyroidectomy: report of one case]

Area of Science:

• Cardiology
• Endocrinology
• Internal Medicine

Background:

• Calcium is crucial for normal heart function.
• Chronic hypoparathyroidism and hypocalcemia can arise secondary to thyroidectomy.
• Levothyroxine supplementation is standard treatment for hypothyroidism.

Observation:

• A 37-year-old woman developed rapid congestive heart failure after starting levothyroxine for post-thyroidectomy hypothyroidism.
• The patient had a history of Graves' disease treated with thyroidectomy at age 18.
• She presented with severe left ventricular dysfunction, valve insufficiency, pulmonary hypertension, and pericardial effusion.

Findings:

• Echocardiography showed severe systolic and diastolic left ventricular dysfunction, mitral and tricuspid valve insufficiency, systolic pulmonary hypertension, left atrial enlargement, and pericardial effusion.
• Treatment with calcium supplementation, diuretics, captopril, and digoxin resulted in rapid clinical improvement.
• Persistent left ventricular dilatation and systolic dysfunction were noted at 18-month follow-up, though other echocardiographic findings improved.

Implications:

• This case highlights a potential link between calcium deficiency and severe cardiac dysfunction.
• Prompt diagnosis and management of hypocalcemia are critical in patients with cardiac symptoms.
• Calcium supplementation can be a vital component in treating heart failure associated with hypoparathyroidism.