Endocrine Abstracts

Introduction: Cardiothyreosis or thyrotoxic heart disease is the most dangerous complication of hyperthyroidism. This rare complication can be revealing and occurs mostly to fragile patients ; eldery or individuals with preexisting cardiac troubles.

Observation: We report the case of a 59 years old male without medical history, who consulted the emergency for dyspnea and palpitations due to atrial fibrillation ( ACFA ) not well tolerated with both respiratory and neurological distress. The patient had amyotrophia, bilateral exophtalmos and a homogeneous goiter with high level of FT4 (48.7 pmol/l ) and low level of TSH (< 0.005 µUI/ml ). The thyroid ultrasound showed a giant multinodular goiter hyperechoic heterogeneous and hypervascular. The diagnosis of grave’ disease was confirmed. We completed the investigation with a cardiac ultrasound that revealed an infero-septo-basal hypokinesia with a left ventricular ejection fraction ( LVEF ) at 50%. The patient received antithyroid medication associeted to B-blockers with progressive decrease in the doses after clinical and biological control. Two weeks later, the patient was no more in an acute condition and he was discharged.

Conclusion: Hyperthyroidism is a frequent disease, revealed after cardiothyreosis can be associeted with higher morbidity and mortality. The ACFA is its most common clinical form and underlying cardiac disease is often present.