[Long-term supraventricular tachycardia in a patient with triiodothyronine toxicosis]

There was presented a case of a therapy-resistant paroxysmal supraventricular tachycardia 130-140/min lasting about 100 days in a 21 years old barmaid drinking 5-6 glasses of natural coffee a day within last 3 years. Supraventricular tachycardia did not impair her working abilities; she was treated with propranolol within last 3 weeks before the admission to hospital. After 4 day therapy with 800 mg of quinidine, 10% potassium chloride and 75 mg of hydroxyzine performed electrocardioversion restored the sinus rhythm 90/min, but unfortunately supraventricular tachycardia returned 4 hours later. Thyroid hormones examination revealed isolated increase of serum T3 level to 3.0 ng/ml (normal value range 0.8-1, 6 ng/ml). Ultrasound examination showed mild parenchymatous goitre. Authors diagnosed a rare type of thyrotoxicosis-triiodothyronine toxicosis+, which was only manifested by long-lasting supraventricular tachycardia without clinical state impairment. Thiamazole-40 mg/day (60 mg from the 28th day of therapy), propranolol-160 mg/day as well as sedatives, 10% KCl and vitamins C and B6 were started to be given. After 72 days of treatment, when serum T3 level lowered to 2.35 ng/ml sinus rhythm 88/min returned, which was proved by 24 hour ECG Holter monitoring. The woman put on weight 10.5 kg during hospitalization and discharged from hospital to out-patient follow-up in good condition. Other authors emphasized that T3-Thyrotoxicosis did not clinically stray from the toxic multinodular or Graves-Basedow's goitre. Three year coffee overdosage deceived physicians at the start of therapy, because its abuse is a known factor inducing supraventricular tachycardia.(ABSTRACT TRUNCATED AT 250 WORDS)