SHM Converge Scientific Abstract ePoster Gallery-Hypothyroidism and Heart Failure: A Case Report

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This document describes the cardiovascular effects of hypothyroidism and presents a clinical case illustrating severe, unrecognized thyroid hormone deficiency in a patient with heart failure.<br /><br />The patient was a 74-year-old woman with a history of heart failure with reduced ejection fraction, chronic kidney disease, and hypertension. She came to the emergency department with two days of shortness of breath and fatigue and was found to be volume overloaded. She was diagnosed with an acute on chronic heart failure exacerbation and started on IV furosemide. However, despite diuresis, she developed worsening hypotension, lethargy, and persistent hypervolemia. Further evaluation revealed that she had known hypothyroidism but had not been taking her prescribed levothyroxine. Laboratory testing showed profound hypothyroidism with a TSH of 331 uIU/L, total T4 of 1.6 mcg/dL, and total T3 of 29 ng/dL. IV levothyroxine was started, after which her volume status and hemodynamics improved, and she was discharged several days later in stable condition.<br /><br />The discussion emphasizes that low thyroid hormone levels can worsen heart failure and make it less responsive to standard therapy. Hypothyroidism is often not suspected initially, but should be considered when a patient fails to improve as expected with conventional heart failure management. Treatment may require IV thyroid hormone replacement in severe cases.<br /><br />The document also summarizes how hypothyroidism contributes to cardiovascular disease through multiple mechanisms, including dyslipidemia, impaired endothelial function, increased arterial stiffness and systemic vascular resistance, decreased cardiac output, reduced contractility, and negative cardiac remodeling. These effects can lead to atherosclerosis, worsened blood pressure control, and heart failure.

Asset Subtitle

Nasser Rizvi

Meta Tag

Author List George W. Garriss III, Nasser Rizvi, Rachel Johnson

Category Clinical Vignettes

Concept Hypothyroidism

Concept Heart Failure

Concept Thyroid Function Tests

Concept Levothyroxine

Concept Dyslipidemia

Distinguished Non-Finalist

Presenter Organization Wellstar - Kennestone Hospital

Presenting Author Nasser Rizvi

Track Adult

Keywords

hypothyroidism

heart failure

levothyroxine

cardiovascular effects

thyroid hormone deficiency

volume overload

hypotension

ejection fraction

endothelial dysfunction

arterial stiffness

Hypothyroidism

Heart Failure

Thyroid Function Tests

Levothyroxine

Dyslipidemia