Thyrotoxic cardiomyopathy: a case report

Department of Internal Medicine, Cardiology, Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova, The 8th International Medical Congress for Students and Young Doctors, September 24-26, 2020Background. Heart failure (HF) is the final common pathway of many cardiovascular diseases. It imposes significant socio-economic and health care burden to both patients and healthcare systems. Although the most common cause of HF is ischemic heart diseases, other less common causes such as hyperthyroidism (thyrotoxicosis), severe anemia, arrhythmia should also be considered during diagnosis to improve overall clinical management of HF. Case report. The 42-year-old man was admitted to cardiology department with mixed (inspiratory and expiratory) dyspnea at moderate effort, palpitations, fatigue, the loss in weight of about 15 kg during 9-10 months. Anamnesis: general condition worsened the last 2 months when appeared generalized edema and mixed dyspnea. During this time did not address to doctor, any treatment has not received. Physical examination revealed swelling in the legs, ankles, ascites, an irregular pulse, at a rate of 130 beats/min, BP- 110/70mmHg. On ECG - atrial fibrillation with rate - 120-57 b/min, electric axis of heart is normal. Signs of left ventricular hypertrophy. The chest X-ray -pulmonary congestion, bilateral pleural effusion. The abdominal X-ray – fluid levels with air on the left. On TTE- thickening of the walls of the aorta and valve apparatus. Dilatation of all heart chambers, significant dilatation of the right atrium and right ventricle, and moderate dilatation of the left atrium and the left ventricle. Contractile function of the left ventricular myocardium is moderately reduced. Ejection fraction = 42%. The second degree mitral regurgitation and third-fourth -degree tricuspid regurgitation. Moderate pulmonary arterial hypertension (PASP= 52mmHg). Sheets of the pericardium are thickened. Fluid in the pleural cavity up to 11 millimeters in the region of the right atrium. Bilateral pleurisy - inhomogeneous fluid with floating elements on the left - about 1,000 milliliters, to the right - about 800 milliliters. Сytological analysis of fluid from pleural cavity pointed to the inflammatory etiology of the effusion. On the ultrasound examination of the thyroid gland – fourth –degree hyperplasia, multiple diffuse changes.On the ultrasound examination of abdominal cavity - ascites, bilateral pleuritic, diffuse changes in the parenchyma of the liver. The glycemic profile -7-00: 4.7 mmol/l, 13-00: 6.3 mmol/l, 17-00: 10.6 mmol/l, glycated hemoglobin - 5,6%. Analysis of thyroid hormones- free Triiodothyronine – 17,22 Pmol/l, free Thyroxine – 79,52 Pmol/l. TSH – ‹ 0, 05 uIU/ml; anti TPO- 144 IU/ml. Tumor marker CA 19-9 -