Thyrotoxicosis induced cardiomyopathy requiring support with extracorporeal membrane oxygenation

Thyrotoxicosis-induced cardiomyopathy (TCM) is a rare, potentially life-threatening complication requiring extracorporeal membrane oxygenation (ECMO) for temporary mechanical support while a euthyroid state is being achieved.

The current review searched Ovid Medline and PubMed for all relevant studies reported in English from January 1, 1970 to December 31, 2017. We included studies where patients were diagnosed with thyrotoxicosis, eventually deteriorating into TCM, requiring veno-arterial ECMO. We were predominantly interested in the clinical pathway that led to the initiation and duration of ECMO, including the trend of ejection fraction (EF) pre- and post-ECMO.

The initial search strategy produced 71 articles of which only 5 studies were eligible for inclusion. These 5 articles included 13 case reports. The majority of the patients (77%) survived with complete recovery of their left ventricular function following initiation of VA-ECMO. Key issues in the current management of TCM are delayed recognition of the underlying thyroid hormone imbalance and when to initiate mechanical support.

The definitive therapy of TCM is returning the patient to a euthyroid state. For those patients who develop circulatory collapse, however, temporary mechanical support should be strongly considered to allow time for a euthyroid state to be achieved.