Thyrotoxic Cardiomyopathy Unveiled: Insights From a Compelling Case Report

Area of Science:

• Cardiology
• Endocrinology
• Internal Medicine

Background:

• Thyrotoxicosis, a state of excess thyroid hormones, significantly impacts cardiovascular function through various mechanisms.
• Thyrotoxic cardiomyopathy (TCM) is a recognized complication, though specific presentations are infrequently reported.
• Heart failure with preserved ejection fraction (HFpEF) is a less common manifestation of TCM.

Observation:

• A 37-year-old female presented with symptoms of thyrotoxicosis and elevated N-terminal pro-b-type natriuretic peptide (NT-proBNP).
• Cardiac imaging revealed bilateral atrial dilatation, preserved left ventricular ejection fraction (LVEF) of 60%, diastolic dysfunction, and severe mitral and tricuspid regurgitation.
• Thyroid function tests confirmed thyrotoxicosis with positive anti-thyroid peroxidase (TPO) and TSH receptor antibodies.

Findings:

• The patient was diagnosed with thyrotoxic cardiomyopathy (TCM) manifesting as HFpEF with predominant atrial involvement.
• Diagnosis was confirmed after excluding other potential causes of heart failure.
• Ultrasonography showed a diffuse goiter, supporting the diagnosis of autoimmune thyroid disease.

Implications:

• This case underscores the importance of considering TCM in patients with unexplained heart failure, particularly those with atrial abnormalities.
• Early detection and prompt, multidisciplinary management involving endocrinologists and cardiologists are crucial for preventing and potentially reversing cardiac complications.
• A high index of suspicion and a comprehensive approach are vital for optimizing patient outcomes in thyrotoxicosis-related cardiovascular disease.