Endocrine Abstracts (2014) 35 P169 | DOI: 10.1530/endoabs.35.P169

Cardiothyreosis: pathogenic conjectures, clinical aspects and surgical approach

Mihai Radu Diaconescu1, Georgeta Datcu2, Mihai Dan Datcu2 & Smaranda Diaconescu3

1‘Gr T Popa’ University of Medicine and Pharmacy. IVth Surgical Clinic*, Iasi, Romania; 2‘Gr T Popa’ University of Medicine and Pharmacy. Ist Medical Clinic**, Iasi, Romania; 3‘Gr T Popa’ University of Medicine and Pharmacy. Vth Pediatrics Clinic***, Iasi, Romania.

Background: The presence of striking cardiovascular manifestations was noted in the first descriptions of hyperthyroidism owing to Parry (1825) and Basedow (1840) in the famous Merseburger triad. Hyperthyroidism may either cause cardiac complication in individuals with a normal myocardium (genuine form of disorder) or complicate pre-existing cardiac troubles.

Patients and methods: An homogenous series of 49 cardiothyreosis, 11 males and 38 females, aged 12–78 (mean 45) years selected between 136 thyrotoxic cases operated on in a period of two decades is herein presented. There were registered 15 Basedow diseases, 16 toxic adenoma and 18 multinodular toxic goitres. Among these were found isolated or dominating when combined together ten cases with cardiac failure, 21 cases with rhythm troubles (four with extrasis tolic arrhythmia and one with fibriloflutter) and nine cases with coronary insufficiency. To these seven hypertensive patients and two cases with mitral valvulopathy were added. In hyperthyroidism clinical diagnostic was confirmed on imaging exams and hormonal determinations while cardio-vascular disturbances was ascertained by interogatory, physic signs, EKG and echocardiography. All our cases were operated on performing 33 near total thyroidectomies and 16 lobectomies without mortality recording yet three postoperative tachyarrhythmias but finally most of them with good clinical results (89.8% cured or significantly ameliorated).

Discussions and conclusions: Pathogenic diagnosis of such so-called ‘cor thyreotoxicum’ is not always easy on account of cardiovascular syndrome which frequently overshowed the thyroid subclinical picture or emergence of new entities as amiodarone induced thyrotoxicosis. In the treatment of cardiothyreosis pharmacologic management realized only transient and in-stable results and radical thyroeliminating procedures should have preference. The single administration of a whole calculated dose of I131 with subsequent treatment with thyrostatics and β-blockers till remission of thyrotoxic is achieved can be chosen opposing to thyroidectomy after short medicamentous preparation which is effective in large thyromegalies and toxic adenoma.

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