Endocrine Abstracts (2017) 49 EP1323 | DOI: 10.1530/endoabs.49.EP1323

Takotsubo cardiomyopathy associated with thyrotoxicosis

Helena Vitorino, Joana Costa, Filipa Moleiro, Cláudia Jesus, Ana Afonso, Nadine Monteiro, Sofia Santos, Eduarda Comenda & Helena Cantante

Hospital Lusíadas Lisboa, Lisboa, Portugal.

Background: Takotsubo cardiomyopathy is a rare, acute, nonischemic cardiomyopathy causing transient systolic disfunction of the apical and/or mid segments of left ventricle and is commonly associated with emotional and physical stress. Thyrotoxicosis is a rare cause of this condition, resulting from direct and indirect action of thyroid hormones on the cardiovascular system.

Case presentation: A 43-year-old woman presented at emergency room with chest pain, shortness of breath, palpitations, nausea, anxiety, slurred speech and myalgia. Two months earlier she had been admitted in another hospital with chest pain and a diagnosed Takotsubo cardiomyopathy, based on normal cardiac catheterization and compatible echocardiographic changes. At admission, diagnosis of recurrent Takotsubo cardiomyopathy in the context of thyrotoxicosis was assumed (TSH <0.05 μm/l, fT4 65 μg/dl). Further evaluation confirmed Graves’ disease. Recomended treatment was started and follow-up at 5 weeks revealed improvement of cardiac function and near normalization of thyroid hormone levels.

Conclusions: Takotsubo cardiomyopathy could be the presenting manifestation of thyroid storm. Awareness of this possible association is important in establishing the diagnosis and institution proper management.

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