Thyrotoxic cardiomyopathy and encephalopathy in a paraplegic man

Case report.

Thyrotoxicosis complicating spinal cord injury is more common than generally appreciated. To raise the level of awareness, the following case of fatal thyrotoxicosis is presented.

A 77-year-old man, paralyzed at the T12 level for 46 years, developed a sudden 42 lb weight loss, dyspnea, interscapular pain, 120/40 mm Hg blood pressure, a nodular thyroid gland, atrial fibrillation, progressive cardiac enlargement, left ventricular ejection fraction diminishing from 30 to 10% and a persistently low level of thyrotropic hormone, 0.05-0.2 microU ml(-1) (normal 0.35-5.5 microU ml(-1)). As coronary artery bypass grafting had been carried out 6 years earlier and other signs of thyrotoxicosis-exophthalmos, lid lag, sweating, tremor and diarrhea-were absent, recurrent arteriosclerotic heart disease was assumed and a trial of thyroid suppression not attempted. He eventually developed depression and memory loss and died in heart failure after a 4-year course of this illness.

This case probably represented a toxic multinodular goiter in an elderly paraplegic man with potentially treatable cardiovascular and nervous system complications.