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Second degree AV block and severely impaired contractility in cardiac myxedema: a case report.

Chatzitomaris A, Scheeler M, Gotzmann M, Köditz R, Schildroth J, Knyhala KM, Nicolas V, Heyer C, Mügge A, Klein HH, Dietrich JW - Thyroid Res (2015)

Bottom Line: Although magnetic resonance imaging of the heart demonstrated decreased cardiac contractility and pericardial effusion, suggesting peri-myocarditis, plasma levels for BNP and troponin I were low.Additionally, bradycardiac episodes abated, although intermittent second degree AV block was still occasionally present during the night.In conclusion, overt hypothyroidism may be associated by cardiac myxedema affecting both electrophysiology and contractility, observations that underscore the necessity of thyroid testing in different phenotypes of heart failure.

View Article: PubMed Central - PubMed

Affiliation: Department of Endocrinology and Diabetes, Medical Hospital I, Bergmannsheil University Hospitals, Ruhr University of Bochum, Bochum, NRW Germany.

ABSTRACT
The heart is a major target organ for thyroid hormone action. Severe overt hypothyroidism can result in diastolic hypertension, lowered cardiac output, impaired left ventricular contractility and diastolic relaxation, pericardial effusion and bradycardia. However, the function of the atrial pacemaker is usually normal and the degree by which the heart rate slows down is often modest. Here we report the case of a 20 year old male Caucasian with severe overt hypothyroidism. He presented with syncopation due to second degree atrioventricular block type Mobitz 2 and heart failure with reduced ejection fraction (38 %). Laboratory testing revealed a severe overt hypothyroidism with markedly elevated TSH (>100 mIU/L) and reduced fT3 and fT4 levels. The condition was caused by hypothyroid Graves' disease (Graves' disease with Hashimoto component). Although magnetic resonance imaging of the heart demonstrated decreased cardiac contractility and pericardial effusion, suggesting peri-myocarditis, plasma levels for BNP and troponin I were low. A possible infectious cause was unlikely, since testing for cardiotropic viruses was negative. The patient was treated with intravenous levothyroxine and after peripheral euthyroidism had been achieved, left ventricular ejection fraction returned to normal and pericardial effusion dissolved. Additionally, bradycardiac episodes abated, although intermittent second degree AV block was still occasionally present during the night. In conclusion, overt hypothyroidism may be associated by cardiac myxedema affecting both electrophysiology and contractility, observations that underscore the necessity of thyroid testing in different phenotypes of heart failure.

No MeSH data available.


Related in: MedlinePlus

Cardiac MRT in peripheral euthyroid state
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Fig3: Cardiac MRT in peripheral euthyroid state

Mentions: Titres of three subtypes of anti-thyroid antibodies were elevated, suggesting hypothyroid Graves’ disease with Hashimoto component (TgAb > 2000 U/mL, TPO-Ab > 3000 U/mL, TRAb 5,9 U/mL). After 3 days the intravenous levothyroxine therapy was terminated and oral substitution continued with a daily dose of 150 μg for 7 days, followed by 125 μg daily. After 7 days an echocardiography revealed normal LVEF and the pericardial effusion had vanished. When peripheral euthyroidism was achieved after 9 days, 24-h Holter ECG monitoring demonstrated regression of the bradycardiac episodes, however an intermittent atrioventricular block Mobitz type 2 during the night remained. A pacemaker was not considered because of a rise in the cardiac frequency during training. In a follow-up MRI investigation after 3 weeks, the initially increased signal intensity in the epicardial layer in T2-weighted and late gadolinium enhancement images had been dissolved (Fig. 3 and Additional file 2). Cardiac output had improved to 6.0 L/min from formerly 3.2 L/min (Table 1).Fig. 3


Second degree AV block and severely impaired contractility in cardiac myxedema: a case report.

Chatzitomaris A, Scheeler M, Gotzmann M, Köditz R, Schildroth J, Knyhala KM, Nicolas V, Heyer C, Mügge A, Klein HH, Dietrich JW - Thyroid Res (2015)

Cardiac MRT in peripheral euthyroid state
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4440534&req=5

Fig3: Cardiac MRT in peripheral euthyroid state
Mentions: Titres of three subtypes of anti-thyroid antibodies were elevated, suggesting hypothyroid Graves’ disease with Hashimoto component (TgAb > 2000 U/mL, TPO-Ab > 3000 U/mL, TRAb 5,9 U/mL). After 3 days the intravenous levothyroxine therapy was terminated and oral substitution continued with a daily dose of 150 μg for 7 days, followed by 125 μg daily. After 7 days an echocardiography revealed normal LVEF and the pericardial effusion had vanished. When peripheral euthyroidism was achieved after 9 days, 24-h Holter ECG monitoring demonstrated regression of the bradycardiac episodes, however an intermittent atrioventricular block Mobitz type 2 during the night remained. A pacemaker was not considered because of a rise in the cardiac frequency during training. In a follow-up MRI investigation after 3 weeks, the initially increased signal intensity in the epicardial layer in T2-weighted and late gadolinium enhancement images had been dissolved (Fig. 3 and Additional file 2). Cardiac output had improved to 6.0 L/min from formerly 3.2 L/min (Table 1).Fig. 3

Bottom Line: Although magnetic resonance imaging of the heart demonstrated decreased cardiac contractility and pericardial effusion, suggesting peri-myocarditis, plasma levels for BNP and troponin I were low.Additionally, bradycardiac episodes abated, although intermittent second degree AV block was still occasionally present during the night.In conclusion, overt hypothyroidism may be associated by cardiac myxedema affecting both electrophysiology and contractility, observations that underscore the necessity of thyroid testing in different phenotypes of heart failure.

View Article: PubMed Central - PubMed

Affiliation: Department of Endocrinology and Diabetes, Medical Hospital I, Bergmannsheil University Hospitals, Ruhr University of Bochum, Bochum, NRW Germany.

ABSTRACT
The heart is a major target organ for thyroid hormone action. Severe overt hypothyroidism can result in diastolic hypertension, lowered cardiac output, impaired left ventricular contractility and diastolic relaxation, pericardial effusion and bradycardia. However, the function of the atrial pacemaker is usually normal and the degree by which the heart rate slows down is often modest. Here we report the case of a 20 year old male Caucasian with severe overt hypothyroidism. He presented with syncopation due to second degree atrioventricular block type Mobitz 2 and heart failure with reduced ejection fraction (38 %). Laboratory testing revealed a severe overt hypothyroidism with markedly elevated TSH (>100 mIU/L) and reduced fT3 and fT4 levels. The condition was caused by hypothyroid Graves' disease (Graves' disease with Hashimoto component). Although magnetic resonance imaging of the heart demonstrated decreased cardiac contractility and pericardial effusion, suggesting peri-myocarditis, plasma levels for BNP and troponin I were low. A possible infectious cause was unlikely, since testing for cardiotropic viruses was negative. The patient was treated with intravenous levothyroxine and after peripheral euthyroidism had been achieved, left ventricular ejection fraction returned to normal and pericardial effusion dissolved. Additionally, bradycardiac episodes abated, although intermittent second degree AV block was still occasionally present during the night. In conclusion, overt hypothyroidism may be associated by cardiac myxedema affecting both electrophysiology and contractility, observations that underscore the necessity of thyroid testing in different phenotypes of heart failure.

No MeSH data available.


Related in: MedlinePlus