Takotsubo cardiomyopathy concurrent with hyperthyroidism following COVID-19-a case report and literature review

The convergence of viral infection, autoimmune thyroid disease, and cardiovascular vulnerability may create a "triple systemic stress" predisposing to Takotsubo cardiomyopathy (TTS). We describe a case illustrating this potential pathophysiological triad.

A previously healthy 21-year-old male presented with sinus tachycardia, anterior ST-segment elevation on preoperative Electrocardiogram (ECG), and regional wall motion abnormalities on echocardiography two weeks after SARS-CoV-2 infection. Emergency coronary angiography ruled out myocardial infarction and coronary stenosis. Clinical features suggested thyrotoxicosis, confirmed by biochemical and imaging studies. Cardiac magnetic resonance demonstrates subendocardial hypoperfusion in the interventricular septum accompanied by abnormal myocardial motion. Treatment with methimazole and beta-blockers led to resolution of cardiac dysfunction and gradual normalization of thyroid function.

This case report describes a temporal association among SARS-CoV-2 infection, exacerbation of autoimmune thyroid dysfunction, and Takotsubo syndrome. The virus may contribute to Graves' disease exacerbation through immune-inflammatory mechanisms, while potentially inducing myocardial stress via cytokine-mediated pathways. These converging factors-combined with thyrotoxicosis-related catecholamine sensitivity-may act synergistically to increase TTS susceptibility. Clinically, thyroid evaluation may be considered in COVID-19 patients presenting with cardiac symptoms, and an integrated management approach addressing viral, endocrine, and cardiovascular aspects could be beneficial. The precise interconnections among these factors remain speculative and warrant further investigation in larger cohorts.