Severe reversible hypocalcemic cardiomyopathy diagnosed 36 years after subtotal thyroidectomy - a case report

Chronic hypocalcemia, irrespectively of its etiology, can lead to severe impairment of the left ventricular (LV) contractility manifesting as dilated cardiomyopathy, usually defined as hypocalcemic cardiomyopathy (hypocaCM). This rarely diagnosed type of heart failure (HF), can be completely reversible, when treated properly with calcium and vitamin D supplementation or, in some subjects, with human recombinant parathormone.

The authors present a case of a 60-year-old male admitted with advanced pulmonary congestion, recurrent pulmonary edema and pleural effusion. He was refractory to standard HF therapy. One year earlier, the patient was diagnosed with primary dilated cardiomyopathy with ejection fraction decreased to 25% and after coronary angiography, which revealed normal coronary arteries, he received implantable cardioverter-defibrillator (ICD). However, 36 years before, the patient underwent subtotal thyroidectomy, and at the moment presented with multiplicitous symptoms suggestive of profound hypocalcemia. Laboratory investigations confirmed hypocalcemia due to iatrogenic hypoparathyroidism. Improvement of LV function during supplementation with calcium and vitamin D was monitored by echocardiography using two-dimensional longitudinal strain. One should always consider reversible causes of HF, including hypocalcemia, especially when obvious consequences of chronic hypocalcemia as myopathy, depression or cataract are seen. Correct therapy can restore LV function and prevent unnecessary implantation of ICD.