SHM Converge Scientific Abstract ePoster Gallery-Severe Case of Thyrotoxicosis Leading to Tachycardia-Induced Cardiomyopathy

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This case describes a 39-year-old man with no significant medical history who presented with palpitations, shortness of breath on exertion, orthopnea, lightheadedness, leg edema, anxiety, and marked weight loss. On exam he was tachycardic and tachypneic. Workup showed severe thyrotoxicosis consistent with Graves’ disease, with suppressed TSH, markedly elevated free T4, and positive thyroid antibodies. His EKG revealed new atrial fibrillation with rapid ventricular response, and imaging showed pulmonary congestion, bilateral pleural effusions, and a transthoracic echocardiogram demonstrating new dilated cardiomyopathy with an ejection fraction of 25–30%.<br /><br />During hospitalization, his respiratory status worsened, requiring IV diuresis, rate control, IV steroids, propranolol, methimazole, breathing treatments, and BiPAP, with ICU transfer for closer monitoring. Because of atrial fibrillation and reduced EF, he was also treated with digoxin, anticoagulation, and guideline-directed heart failure therapy including lisinopril and spironolactone. He was discharged on methimazole, beta-blocker therapy, Eliquis, and heart failure medications, with a LifeVest and cardiology follow-up.<br /><br />The case highlights that uncontrolled hyperthyroidism can cause serious arrhythmias and, rarely, tachycardia-induced dilated cardiomyopathy. Importantly, the cardiomyopathy may be reversible once thyroid hormone levels are controlled. In this patient, follow-up echocardiography 6 months later showed significant improvement in EF to 40–45%, and the LifeVest was discontinued. This report emphasizes the importance of recognizing thyrotoxicosis as a potential cause of acute heart failure and treating it promptly to prevent long-term cardiac damage.

Asset Subtitle

Manisha Piryani

Meta Tag

Author List Angelina Piryani, Charn Nandra, Ehab Alshurbaji, Golnaz K. Holm, Manisha Piryani, Mounica A. Pothacamuri, Satish Magge

Category Clinical Vignettes

Concept Thyrotoxicosis

Concept Tachycardia-Induced Cardiomyopathy

Concept Heart Failure

Concept Atrial Fibrillation

Concept Beta-Blockade

Distinguished Non-Finalist

Presenter Organization Trinity Health System

Presenting Author Manisha Piryani

Track Adult

Keywords

Graves disease

thyrotoxicosis

atrial fibrillation

rapid ventricular response

dilated cardiomyopathy

heart failure

ejection fraction

tachycardia-induced cardiomyopathy

methimazole

LifeVest

Thyrotoxicosis

Tachycardia-Induced Cardiomyopathy

Heart Failure

Atrial Fibrillation

Beta-Blockade