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Takotsubo Cardiomyopathy could occur in patients with apathetic hyperthyroidism.
MedLine Citation:
PMID:  23885758     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Background: Takotsubo cardiomyopathy is a rare myocardial stunning syndrome with a presentation that can mimic acute myocardial infarction. It almost always occurs in elderly women and is usually precipitated by an emotional or physical stressful event. Thyrotoxicosis is one of the medical conditions associated with Takotsubo cardiomyopathy although this association has been rarely reported. Apathetic hyperthyroidism had never been reported to be associated with Takotsubo cardiomyopathy. We present a case of female patient presenting with Takotsubo cardiomyopathy with apathetic hyperthyroidism due to (non-diagnosed) Graves' disease as precipitating factor. Patient findings: A 70-year-old female patient was admitted to the emergency department with hemodynamic shock and acute coronary syndrome. Cardiac catheterization eliminated coronary lesions and showed the characteristic apical ballooning of Takotsubo cardiomyopathy. Due to lack of specific symptoms hyperthyroidism was not suspected until few days later when her clinical course was complicated by atrial fibrillation. She was found to have low TSH levels with elevated thyroid hormone levels and positive TSH receptor antibodies. She was treated with carbimazole, beta-blockers and potassium perchlorate with complete recovery of cardiac function within one month. Summary: This case draws our attention that takotsubo cardiomyopathy could occur in patients with apathetic hyperthyroidism and it could represent the first major manifestation of a pauci-symptomatic thyroid disease. Conclusion: As Takotsubo cardiomyopathy affects especially the elderly and as clinical presentation is not a reliable indicator to diagnose hyperthyroidism in this group of patients, we propose that TSH assay should be performed in every case of Takotsubo cardiomyopathy even in the absence of history of thyroid disease. This is particularly important in the elderly women and when no clear cause is evidenced.
Authors:
Abdallah Al-Salameh; Jennifer Allain; Patrick Meimoun; Taher Benali; Rachel Desailloud
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-7-25
Journal Detail:
Title:  Thyroid : official journal of the American Thyroid Association     Volume:  -     ISSN:  1557-9077     ISO Abbreviation:  Thyroid     Publication Date:  2013 Jul 
Date Detail:
Created Date:  2013-7-26     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9104317     Medline TA:  Thyroid     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
Amiens University Hospital, Endocrinology, Amiens, France ; abdallahalsalameh@hotmail.com.
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