propylthiouracil and Takotsubo-Cardiomyopathy

A 65-year-old woman presented to the hospital with weight loss and diarrhea. A diagnosis of thyroid storm was established by the presence of fever, lethargy, tachycardia, heart failure (HF), and abnormal thyroid function tests. An acute coronary syndrome (ACS) was suspected because of anteroseptal ST-segment elevations on electrocardiogram and severe left ventricular (LV) dysfunction with apical dilation on echocardiogram. The ejection fraction (EF) was 25%. Treatment for ACS and HF was begun. Coronary arteriography revealed normal coronaries. Propylthiouracil and corticosteroids were added to treat thyrotoxicosis. On Day 4, repeat echocardiography confirmed an EF of 65% and complete resolution of LV dysfunction and cavity dilation. Reversible LV dysfunction and apical cavity dilation is consistent with Takotsubo cardiomyopathy. While commonly associated with psychological trauma, its association with thyroid storm has only been reported twice before. Knowledge of this possible association is of importance in establishing the diagnosis and instituting a proper treatment plan.

Topics: Adrenergic beta-Antagonists; Aged; Antithyroid Agents; Coronary Angiography; Diagnosis, Differential; Drug Therapy, Combination; Echocardiography; Electrocardiography; Female; Follow-Up Studies; Glucocorticoids; Humans; Hydrocortisone; Propranolol; Propylthiouracil; Takotsubo Cardiomyopathy; Thyroid Crisis; Thyroxine; Triiodothyronine; Ventricular Function, Left