Endocrine Abstracts

Cardiomyopathy can occur due to hypothyroidism or hypocalcemia but often resolves with judicious treatment with levothyroxine and correcting calcium levels to acceptable levels. We discuss a case of a 37-year-old woman presenting with acute cardiogenic shock and a history of total thyroidectomy 6 years prior for papillary thyroid carcinoma stage 1 (T2N1aM0). Patient was non-compliant to levothyroxine treatment and developed easy fatigability and exertional dyspnea 5 months before consult. Patient had no previous co-morbidities, and no family history of heart diseases. Workup was consistent with primary hypothyroidism with an elevated TSH and low free thyroid hormones. Serum calcium was also low and was attributed to post-surgical hypoparathyroidism. Neck ultrasound confirmed absent thyroid glands. Chest radiograph show massive cardiomegaly, which on trans-thoracic echocardiogram (TTE) showed minimal pericardial effusion, global hypokinesia, an ejection fraction of 20%, and a dilated left ventricle. After initial stabilization with inotropes, patient was started on low dose of levothyroxine at 25 μg/day and digoxin. Hypocalcemia was corrected to lower limit of normal with calcitriol 0.5 μg/day and calcium carbonate 2 g/day. She was discharged after a few weeks with gradual up-titration of levothyroxine at 12.5 μg/day depending on clinical tolerability. Euthyroidism was achieved at levothyroxine 125 μg/day and 8 months post-discharge, previous functional capacity was achieved at 4–10 METs with an improved ejection fraction of 62% on repeat TTE.

Keywords: hypothyroidism, hypocalcemia, cardiomyopathy, cardiogenic shock.

Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.

Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.