Endocrine Abstracts

Introduction: Takotsubo disease is a non-ischemic, reversible form of cardiomyopathy, triggered by intense emotional or physical stress. Characterized by normal coronaries and a particular ventricular contraction, it is also known as ‘apical ballooning syndrome’. Thyrotoxicosis, especially Graves’ disease, has been associated with Takotsubo cardiomyopathy.

Case report: We report the coexistence of Takotsubo cardiomyopathy in a 37 year old female patient presenting with thyroid storm secondary to untreated Graves’ disease. Addressed to the emergency unit with suspicion of acute coronary syndrome, signs of lateral inferior apical ST-segment elevation were noticed on the ECG. At clinical examination: pale wet teguments, tachycardia, visible goiter and bilateral exophtalmia. According to the Burch Wartofsky criteria for thyrotoxicosis the patient had a score of 70, highly suggestive for thyreotoxic crisis, sustained by the biological data (high free T4 5.27 ng/dl and free T3 7.47 pg/ml levels with inhibited TSH 0.008 uUI/ml). She also associated anemia, inflammatory syndrome and important hepatocytolisis. Echocardiographic she presented a severely impaired left ventricular systolic function (ejection fraction 15%) with apical ballooning and elevated left ventricular end diastolic pressure. Coronary angiography revealed non-obstructive coronary atheroma. The final diagnosis of Takotsubo cardiomyopathy was made on the basis of cardiac computer tomography. At the 7 weeks follow up, under antithyroid drugs there was an improvement of thyroid hormone levels. Moreover, consistent with Takotsubo cardiomyopathy, at re-evaluation there was a cardiac function recovery with normal ejection fraction (66%).

Conclusions: Thyrotoxicosis is associated with multiple implications in cardiovascular system. Pathologically high levels of thyroid hormones cause exaggerated chronotropic and inotropic response to cathecolaminee. One possible explanation could be the upregulation of beta adrenergic receptors by thyroid hormones in many tissues, including cardiac.