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Cardiomyopathy associated with Graves' disease
H Koshiyama1, D F Sellitti, T Akamizu
1Department of Internal Medicine, Hyogo Prefectural Amagasaki Hospital, Japan.
Insights
Graves' disease can cause heart failure through cardiomyopathy. Autoimmunity against the TSH receptor (TSH-R) may link heart and eye conditions in Graves' disease patients.
Area of Science:
- Endocrinology and Cardiology
- Molecular Biology and Immunology
Background:
- Cardiovascular manifestations in Graves' disease are typically attributed to elevated thyroid hormone levels.
- This case explores a potential autoimmune mechanism beyond hormonal effects in Graves' disease.
Observation:
- A 25-year-old male with Graves' disease presented with severe cardiomyopathy and heart failure.
- Myocardial biopsies revealed fibroblast infiltration and degenerative changes.
- The patient later developed goiter, hyperthyroidism, and Graves' ophthalmopathy, suggesting a unified pathological process.
Findings:
- Thyroid stimulating hormone receptor (TSH-R) mRNA was detected in human heart tissue via RT-PCR and DNA sequencing.
- These findings indicate the presence of TSH-R in the heart, a potential target for autoimmunity.
Implications:
- Autoimmunity directed against the TSH receptor may be a contributing factor to both cardiomyopathy and ophthalmopathy in certain Graves' disease cases.
- This suggests TSH-R as a potential common target in the pathogenesis of Graves' disease complications.
- Further research into TSH-R autoimmunity could lead to novel therapeutic strategies for cardiovascular and ocular manifestations.
Abstract:
Cardiovascular changes associated with Graves' disease are generally considered to be secondary to the increased levels of thyroid hormone. We describe a case of Graves' disease in a 25-year-old man, who developed cardiomyopathy with severe heart failure. Pathological examination of the myocardial biopsies showed fibroblast infiltration and degenerative changes. After the cardiomyopathy subsided the patient developed a goitre and signs of hyperthyroidism, followed by Graves' ophthalmopathy, which was treated successfully with a combination of high-dose corticosteroids and orbital radiotherapy. These findings suggested a common pathogenesis for the cardiomyopathy and ophthalmopathy, and prompted us to investigate the expression of TSH receptor (TSH-R) in human heart. TSH-R mRNA was identified in human heart using the reverse transcriptasepolymerase chain reaction (RT-PCR) and DNA sequencing. Taken together, these data suggest that autoimmunity against the TSH-R might contribute to both the cardiomyopathy and ophthalmopathy in similar cases of Graves' disease.