Long QT interval and ventricular tachycardia of "torsade de pointe" type in hypothyroidism

We have observed two patients with long QT interval, ventricular tachycardias of "torsade de pointe" type and repeated ventricular fibrillation episodes, who also turned out to have significant hypothyroidism. This was suspected from the clinical picture in one patient and after haematological test in the other. In addition to hypothyroidism, both patients had associated factors which may have contributed to the development of the arrhythmia. After having reached an euthyroid state, both patients normalized their QT intervals, were relieved from earlier symptoms of cardiac arrhythmias and exhibited no longer any documented arrhythmia. Before thyroid substitution, both patients had marked signs of delayed ventricular repolarization even by invasive electrophysiological methods. Our observations indicate that hypothyroidism should be considered a possible primary cause in cases with long QT syndrome (LQTS). Furthermore, the possibility of LQTS in patients with hypothyroidism should be considered.