Endocrine Abstracts

History: A 51-year-old man presented to the Emergency Department in February 2023 with shortness of breath, palpitations and tremor. He had a background of atrial fibrillation with rapid ventricular rate, anxiety, depression, asthma, excess alcohol consumption, and known a user of Heroin and Cocaine. He was diagnosed with worsening thyrotoxicosis on a background of known hyperthyroidism. He had been non adherent with his Carbimazole for the previous two weeks. He was discharged with Carbimazole and propranolol and counselled on the importance of adherence. In July 2023, he re-presented to the Emergency Department with breathlessness and was diagnosed with congestive heart failure.

Course of illness: When he re-presented, he stated that he had not been taking his medications for many months. An echocardiogram showed severe LV dysfunction. He was diagnosed with Decompensated HFrEF secondary to Thyrotoxicosis likely because of non-adherence to his medications. He was admitted and managed with diuretics, rate control and anticoagulation. He improved clinically and a follow up in cardiology clinic was arranged however, he did not attend this appointment. Subsequently, attended a nurse led heart failure clinic facilitated from prison. After further discussion, the cardiology team have planned to implant a CRT device for his heart failure. In October 2024, he belatedly attended his endocrine clinic appointment and has taken his Carbimazole regularly for the past 2 months, but the cardiac issues are permanent.

Conclusion and Points for Discussion: In conclusion, this case highlights the complex psychosocial factors contributing to adverse patient outcomes. This patient had a potentially preventable cause of heart failure; however, the treatment delivery was complicated by multiple factors. These include – treatment adherence, illicit drug use, unhealthy alcohol use, lack of social support and mental health diagnoses. When managing such patients it may be worthwhile to address these factors alongside the hyperthyroidism treatment.