Hypothyroid cardiomyopathy: echocardiographic documentation of reversibility

The concept of hypothyroid heart disease remains controversial. Although hemodynamic abnormalities have been described, the presence of underlying abnormal cardiac structures has not been confirmed. The authors studied 20 hypothyroid patients using M-mode echocardiography before and after l-thyroxine therapy. Fifteen additional hypothyroid patients were studied using two-dimensional echocardiography to confirm the data of the first study. The findings were the same in both studies: during hypothyroidism, the interventricular septum is thickened, the ratio of septal thickness to left ventricular posterior wall thickening is increased, the right ventricular wall is thickened, regional wall motion of interventricular septum and right ventricular wall is decreased, and global function of the left ventricle is decreased. These findings are reversed with l-thyroxine therapy; they occur within 6 months of the development of hypothyroidism, but appear unrelated to elevated TSH levels. Whether the thickened interventricular septum and right ventricular wall represent true muscular hypertrophy requires further elucidation. Nevertheless, these data demonstrate the existence of a hypothyroid cardiomyopathy.