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Širvys A, Baranauskas A, Budrys P. A Rare Encounter: Unstable Vasospastic Angina Induced by Thyrotoxicosis. J Clin Med 2024; 13:3130. [PMID: 38892840 PMCID: PMC11172422 DOI: 10.3390/jcm13113130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 05/24/2024] [Accepted: 05/25/2024] [Indexed: 06/21/2024] Open
Abstract
Coronary artery vasospasm plays a crucial role in the prevalence of unstable angina. Despite common misdiagnosis, there is limited evidence on this topic. Here, we present a rare case of unstable vasospastic angina in a female with severe thyrotoxicosis. Case Report: A 62-year-old female patient was admitted to the cardiac intensive care unit due to crushing chest pain at rest. The patient exhibited ischemic changes on the ECG with a normal troponin I level. Recurrent chest pain prompted urgent coronary angiography, revealing generalized vasospasm of all coronary artery branches including the left main coronary artery. Intracoronary nitroglycerin injection partially alleviated the vasospasm; however, there was a persistent stenosis in the left main artery. Subsequent intravascular ultrasound demonstrated an anatomically normal left main artery. Post-procedure, laboratory tests revealed undetectable levels of thyroid-stimulating hormone and thyroid hormones above the detectable level. The patient was initiated on methimazole and discharged symptom-free, expecting a good prognosis under conservative management. Conclusions: Clinically significant coronary vasospasm triggered by thyrotoxicosis remains a rarity in clinical practice, often posing diagnostic challenges. This case emphasizes the significance of intracoronary nitroglycerin and intravascular ultrasound in discerning the etiology of coronary lesions seen on angiography. We advocate for these techniques to optimize invasive coronary artery diagnostics, enabling the selection of the appropriate treatment strategies and improving long-term prognosis.
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Affiliation(s)
- Artiomas Širvys
- Clinic of Cardiac and Vascular Diseases, Faculty of Medicine, Vilnius University, 03101 Vilnius, Lithuania; (A.B.); (P.B.)
- Cardiology and Angiology Center, Vilnius University Hospital Santaros Klinikos, 08410 Vilnius, Lithuania
| | - Arvydas Baranauskas
- Clinic of Cardiac and Vascular Diseases, Faculty of Medicine, Vilnius University, 03101 Vilnius, Lithuania; (A.B.); (P.B.)
- Cardiology and Angiology Center, Vilnius University Hospital Santaros Klinikos, 08410 Vilnius, Lithuania
| | - Povilas Budrys
- Clinic of Cardiac and Vascular Diseases, Faculty of Medicine, Vilnius University, 03101 Vilnius, Lithuania; (A.B.); (P.B.)
- Cardiology and Angiology Center, Vilnius University Hospital Santaros Klinikos, 08410 Vilnius, Lithuania
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Mouna E, Molka BB, Sawssan BT, Dhoha BS, Khouloud B, Nadia C, Fatma M, Fatma M, Mouna M, Nabila R, Faten HK, Mohamed A. Cardiothyreosis: Epidemiological, clinical and therapeutic approach. Clin Med Insights Cardiol 2023; 17:11795468231152042. [PMID: 36727115 PMCID: PMC9885034 DOI: 10.1177/11795468231152042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 01/03/2023] [Indexed: 01/29/2023] Open
Abstract
Introduction Cardiothyreosis corresponds to the cellular effects of free thyroid hormones on the vascular wall and the myocardium. We aim to describe the clinical, para-clinical and therapeutic aspects of cardiothyreosis and to detail prognostic factors. Methods We conducted a descriptive retrospective study at the Endocrinology-Diabetology Department of the Hedi Chaker University Hospital in Sfax-Tunisia. We collected medical records of 100 patients with cardiothyreosis between January 1999 and December 2019. We included patients with cardiothyreosis who underwent adequate cardiac evaluation. We excluded patients with cardiac abnormalities related to conditions other than hyperthyroidism, patients who died and patients without cardiothyreosis. Results We included 100 adult patients (43 men and 57 women). The mean age was 49.3 ±12.9 years (20-79 years). The diagnosis of cardiothyreosis was concomitant with that of hyperthyroidism in 72% of cases. Weight loss and palpitations were the two most frequently reported signs in 91% of cases each. Hypertension was systolic in 15 patients. The average heart rate was 103.1 beats/min (52-182 bpm). The mean TSH and FT4 levels were 0.042 μIU/ml and 59.6 pmol/l, respectively. Rhythm disorders and heart failure were the most common cardiac complications with 81 and 56 cases, respectively. Cardiac ultrasound showed dilatation of the left atrium in 28.3% of patients. Pulmonary arterial hypertension was present in 43% of cases. 57 patients had been treated with benzylthiouracil at a mean dose of 157.45 mg/day. Radical treatment with radioactive iodine was indicated in 81 patients. The evolution of cardiothyreosis was favourable in 58 patients. Conclusion Cardiothyreosis is a serious complication of hyperthyroidism. Future prospective studies will be of great help to better characterise and manage cardiothyreosis.
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Affiliation(s)
- Elleuch Mouna
- Elleuch Mouna, Department of Endocrinology
Diabetology, Hedi Chaker hospital, University of Sfax, Sfax, 3089, Tunisia.
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Watanabe N, Yoshimura Noh J, Hattori N, Iwaku K, Suzuki N, Yoshihara A, Ohye H, Suzuki M, Matsumoto M, Endo K, Kunii Y, Takagi G, Sugino K, Ito K. Cardiac Troponin Is Elevated in Patients with Thyrotoxicosis and Decreases as Thyroid Function Improves and Brain Natriuretic Peptide Levels Decrease. Eur Thyroid J 2021; 10:468-475. [PMID: 34956919 PMCID: PMC8647084 DOI: 10.1159/000510619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 07/28/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION High-sensitive cardiac troponin reflects micro-myocardial injury in the absence of overt myocardial infarction. OBJECTIVE This study aimed to clarify how thyrotoxicosis affects cardiac troponin. METHODS This was a prospective observational study in Japan. Untreated patients with thyrotoxicosis who visited Ito Hospital were enrolled, and medical treatment was initiated for hyperthyroidism. Thyroid function, high-sensitive troponin I (hsTnI), and brain natriuretic peptide (BNP) were measured at baseline and then every 3 months for 1 year. RESULTS Data from a total of 143 patients (median age, 42 years; 32 men and 111 women) were investigated. At baseline, median hsTnI was 1.9 pg/mL and ranged from 0 to 69.6 pg/mL. Five patients (3.5%) had a high hsTnI value that exceeded 26.2 pg/mL, which is used as the cutoff for diagnosis of myocardial infarction, and 22 patients (15.4%) had an intermediate value between 5.0 and 26.2 pg/mL. Multivariable regression analysis showed that significant predictors of the hsTnI value were age (β = 0.20, p = 0.01) and BNP (β = 0.43, p < 0.0001) (R2 = 0.27, F = 26.0, p < 0.0001), and significant predictors of the BNP value were age (β = 0.23, p = 0.001), hemoglobin (β = -0.43, p < 0.0001), free T4 (FT4) (β = 0.23, p = 0.001), and hsTnI (β = 0.27, p < 0.0001) (R2 = 0.49, F = 33.8, p < 0.0001). Correlations were found between a decrease in hsTnI and BNP in the first 3 months (ρ = 0.49, p < 0.0001). A decrease in FT4 in the first 3 months was weakly correlated with decreases in hsTnI (ρ = 0.32, p = 0.0004) and BNP (ρ = 0.32; p = 0.0003). Of the 27 patients with elevated hsTnI (≥5.0 pg/mL), the hsTnI level was normalized in 20 patients within a year. CONCLUSIONS In thyrotoxicosis, the myocardial biomarker hsTnI is elevated in about 20% of patients; hsTnI levels decrease as thyroid function improves and BNP decreases.
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Affiliation(s)
- Natsuko Watanabe
- Department of Internal Medicine, Ito Hospital, Tokyo, Japan
- *Natsuko Watanabe, Department of Internal Medicine, Ito Hospital, 4-3-6 Jingumae, Shibuya-ku, Tokyo 150-8308 (Japan),
| | | | - Naomi Hattori
- Department of Internal Medicine, Ito Hospital, Tokyo, Japan
| | - Kenji Iwaku
- Department of Internal Medicine, Ito Hospital, Tokyo, Japan
| | - Nami Suzuki
- Department of Internal Medicine, Ito Hospital, Tokyo, Japan
| | - Ai Yoshihara
- Department of Internal Medicine, Ito Hospital, Tokyo, Japan
| | - Hidemi Ohye
- Department of Internal Medicine, Ito Hospital, Tokyo, Japan
| | - Miho Suzuki
- Department of Internal Medicine, Ito Hospital, Tokyo, Japan
| | | | - Kei Endo
- Department of Internal Medicine, Ito Hospital, Tokyo, Japan
| | - Yo Kunii
- Department of Internal Medicine, Ito Hospital, Tokyo, Japan
| | - Gen Takagi
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | | | - Koichi Ito
- Department of Surgery, Ito Hospital, Tokyo, Japan
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Yamazaki K, Minakata K, Nakane T, Kawatou M, Minatoya K, Sakata R. Thyroid storm after mitral valve repair in a patient with Becker muscular dystrophy. J Card Surg 2020; 36:739-742. [PMID: 33305858 DOI: 10.1111/jocs.15245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 11/21/2020] [Accepted: 11/27/2020] [Indexed: 11/26/2022]
Abstract
A 40-year-old male with Becker muscular dystrophy presented with severe mitral regurgitation and underwent mitral valve repair. Following the surgery, the patient became tachycardic and developed a continuous high-grade fever and hyperbilirubinemia. The patient's condition worsened and we eventually tested his thyroid levels and discovered abnormally high thyroid levels. After diagnosing a severe thyroid storm, the patient was treated with oral administration of Lugol's iodine and thiamazole, as well as an intravenous steroid, which led to an immediate improvement of symptoms. The incidence of thyroid storm after open-heart surgery is extremely rare but highly life-threatening if unrecognized.
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Affiliation(s)
- Kazuhiro Yamazaki
- Department of Cardiovascular Surgery, Graduate of School of Medicine, Kyoto University, Kyoto, Japan
| | - Kenji Minakata
- Department of Cardiovascular Surgery, Graduate of School of Medicine, Kyoto University, Kyoto, Japan
| | - Takeichiro Nakane
- Department of Cardiovascular Surgery, Graduate of School of Medicine, Kyoto University, Kyoto, Japan
| | - Masahide Kawatou
- Department of Cardiovascular Surgery, Graduate of School of Medicine, Kyoto University, Kyoto, Japan
| | - Kenji Minatoya
- Department of Cardiovascular Surgery, Graduate of School of Medicine, Kyoto University, Kyoto, Japan
| | - Ryuzo Sakata
- Department of Cardiovascular Surgery, Graduate of School of Medicine, Kyoto University, Kyoto, Japan
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Takahashi M, Kondo T, Yamasaki G, Sugimoto M, Kuse A, Morichika M, Nakagawa K, Ueno Y. An autopsy case of thyroid storm associated with chronic lymphocytic thyroiditis. Leg Med (Tokyo) 2019; 44:101624. [PMID: 32259690 DOI: 10.1016/j.legalmed.2019.101624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 08/15/2019] [Accepted: 09/03/2019] [Indexed: 11/17/2022]
Abstract
A Japanese woman in her 30s was found dead on a mattress. She had had fever, cough, and dyspnea for about 2 weeks. Gross examination at autopsy revealed slight enlargement of the thyroid gland and histopathological examination resulted in a diagnosis of chronic lymphocytic thyroiditis. The concentration of triiodothyronine in the cadaveric blood was extraordinarily high, whereas that of thyroid stimulating hormone was below the detection limit. Autoimmune antibodies against thyroid tissue were positive. The cause of death was assumed to be congestive heart failure caused by thyroid storm associated with chronic lymphocytic thyroiditis. Systemic histopathological examination of tissues and postmortem biochemistry can enable a diagnosis in medicolegal autopsies.
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Affiliation(s)
- Motonori Takahashi
- Division of Legal Medicine, Department of Community Medicine and Social Health Science, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, Japan.
| | - Takeshi Kondo
- Division of Legal Medicine, Department of Community Medicine and Social Health Science, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, Japan
| | - Gentaro Yamasaki
- Division of Legal Medicine, Department of Community Medicine and Social Health Science, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, Japan
| | - Marie Sugimoto
- Division of Legal Medicine, Department of Community Medicine and Social Health Science, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, Japan
| | - Azumi Kuse
- Division of Legal Medicine, Department of Community Medicine and Social Health Science, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, Japan
| | - Mai Morichika
- Division of Legal Medicine, Department of Community Medicine and Social Health Science, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, Japan
| | - Kanako Nakagawa
- Division of Legal Medicine, Department of Community Medicine and Social Health Science, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, Japan
| | - Yasuhiro Ueno
- Division of Legal Medicine, Department of Community Medicine and Social Health Science, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, Japan
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Li C, Chen F, Yu X, Hu S, Shao S. A silent myocardial infarction with normal coronary arteries associated with Graves' disease. Heart Lung 2018; 48:347-350. [PMID: 30503299 DOI: 10.1016/j.hrtlng.2018.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 11/15/2018] [Accepted: 11/19/2018] [Indexed: 11/17/2022]
Abstract
Acute myocardial infarction (AMI) is a scarce but fatal complication in Graves' disease (GD). Silent myocardial infarction (MI) associated with GD has never been reported. A 37-year-old male patient was admitted due to poorly controlled hyperthyroidism and persistent fever. But the patient did not complain of chest pain on admission. The electrocardiogram (ECG) showed Q waves and ST-segment elevations. Cardiac troponin I (cTnI) was sharply increased. He was qualified to an emergency coronary angiography which showed normal coronary arteries without any stenosis. The potential mechanisms for AMI with angiographically normal coronary arteries in the setting of hyperthyroidism may be attributed to the hyper-metabolic state due to thyrotoxicosis, severe vasospasm in coronary artery, coagulation abnormalities, and the inflammatory/autoimmune milieu. In conclusion, patients with GD-associated silent MI are unusual. Early recognition and diagnosis by clinicians provide a better prognosis. This case demonstrates the importance of ECG and cTnI screening among GD patients.
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Affiliation(s)
- Chunyu Li
- Division of Endocrinology, Tongji Hospital, Huazhong University of Science & Technology, Jiefang Road 1095, Wuhan 430030, Hubei, PR China
| | - Fuqiong Chen
- Division of Endocrinology, Tongji Hospital, Huazhong University of Science & Technology, Jiefang Road 1095, Wuhan 430030, Hubei, PR China
| | - Xuefeng Yu
- Division of Endocrinology, Tongji Hospital, Huazhong University of Science & Technology, Jiefang Road 1095, Wuhan 430030, Hubei, PR China
| | - Shuhong Hu
- Division of Endocrinology, Tongji Hospital, Huazhong University of Science & Technology, Jiefang Road 1095, Wuhan 430030, Hubei, PR China.
| | - Shiying Shao
- Division of Endocrinology, Tongji Hospital, Huazhong University of Science & Technology, Jiefang Road 1095, Wuhan 430030, Hubei, PR China.
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Rymer De Marchena I, Gutman A, Zaidan J, Yacoub H, Hoyek W. Thyrotoxicosis Mimicking ST Elevation Myocardial Infarction. Cureus 2017; 9:e1323. [PMID: 28690956 PMCID: PMC5501718 DOI: 10.7759/cureus.1323] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Hyperthyroidism is well known to be associated with cardiac disease. Delay in making the diagnosis and occurrence of complications are common and are associated with a worse outcome. A 54-year-old male, non-smoker, with no past medical history and no significant family history presented to our hospital with severe left sided chest pain, “crushing” in nature. Electrocardiogram showed ST-segment elevations in the inferior leads. Troponin I level was 0.32 ng/mL (normal range 0-0.05 ng/mL) on presentation. The patient underwent an emergent coronary angiography which showed no evidence of occlusive coronary artery disease. The patient’s symptoms and signs prompted a high suspicion of thyrotoxicosis which was subsequently confirmed by a low thyroid stimulating hormone and high free thyroxine levels. The patient was given Methimazole and atenolol and his symptoms resolved. Awareness of coronary vasospasm due to thyrotoxicosis should be raised in patients presenting with typical angina pectoris with subsequent normal coronary angiographic results. History and physical examination may suggest underlying hyperthyroidism, but the absence of typical findings does not rule out the diagnosis.
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Affiliation(s)
| | - Anna Gutman
- Internal Medicine, Staten Island University Hospital, Northwell Health
| | - Julie Zaidan
- Internal Medicine, Staten Island University Hospital, Northwell Health
| | - Harout Yacoub
- Cardiology, Staten Island University Hospital, Northwell Health
| | - Wissam Hoyek
- Cardiology, Staten Island University Hospital, Northwell Health
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Zheng W, Zhang YJ, Li SY, Liu LL, Sun J. Painless thyroiditis-induced acute myocardial infarction with normal coronary arteries. Am J Emerg Med 2015; 33:983.e5-10. [PMID: 25662207 DOI: 10.1016/j.ajem.2014.12.071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 12/14/2014] [Indexed: 10/24/2022] Open
Affiliation(s)
- Wen Zheng
- Department of Cardiology, the First Hospital of Jilin University, Changchun, China.
| | - Yu-Jiao Zhang
- Department of Cardiology, the First Hospital of Jilin University, Changchun, China.
| | - Shu-Yan Li
- Department of Cardiology, the First Hospital of Jilin University, Changchun, China.
| | - Lu-Lun Liu
- Thyroid Surgery Department, the First Hospital of Jilin University, Changchun, China.
| | - Jian Sun
- Department of Cardiology, the First Hospital of Jilin University, Changchun, China.
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Freitas F, Estato V, Lessa MA, Tibiriçá E. Cardiac microvascular rarefaction in hyperthyroid rats is reversed by losartan, diltiazem, and propranolol. Fundam Clin Pharmacol 2014; 29:31-40. [DOI: 10.1111/fcp.12075] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Revised: 02/21/2014] [Accepted: 03/27/2014] [Indexed: 12/17/2022]
Affiliation(s)
- Felipe Freitas
- Laboratory of Cardiovascular Investigation; Oswaldo Cruz Institute; FIOCRUZ; Rio de Janeiro Brazil
| | - Vanessa Estato
- Laboratory of Cardiovascular Investigation; Oswaldo Cruz Institute; FIOCRUZ; Rio de Janeiro Brazil
| | - Marcos A. Lessa
- Laboratory of Cardiovascular Investigation; Oswaldo Cruz Institute; FIOCRUZ; Rio de Janeiro Brazil
| | - Eduardo Tibiriçá
- Laboratory of Cardiovascular Investigation; Oswaldo Cruz Institute; FIOCRUZ; Rio de Janeiro Brazil
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Brooks MJ, Pattison DA, Teo EP, Price S, Gurvitch R. Amiodarone-induced destructive thyroiditis associated with coronary artery vasospasm and recurrent ventricular fibrillation. Eur Thyroid J 2013; 2:65-7. [PMID: 24783040 PMCID: PMC3821493 DOI: 10.1159/000345528] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Revised: 10/29/2012] [Indexed: 12/20/2022] Open
Abstract
A 55-year-old male on long-term amiodarone therapy presented with ischaemic chest pain and recurrent unwitnessed syncope. Interrogation of his internal cardiac defibrillator, which had been inserted 4 years earlier, revealed two episodes of ventricular fibrillation, the timing of which corresponded to his syncopal events. Severe spontaneous coronary artery vasospasm was observed on coronary angiogram. Thyroid function testing revealed severe hyperthyroidism with a diagnosis of type 2 amiodarone-induced thyrotoxicosis (AIT) subsequently made. Treatment with prednisolone therapy was commenced and thyroid function rapidly normalized. Prednisolone was weaned without recurrence of hyperthyroidism and on last review, 6 months after initial presentation, he remains free from further chest pain and arrhythmias. Our patient's presentation is a very rare case of AIT-associated coronary artery spasm and documented ischaemic ventricular fibrillation with fortunate survival.
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Affiliation(s)
- Matthew J. Brooks
- Department of Cardiology, The Royal Melbourne Hospital, Melbourne, Vic., Australia
- *Matthew Brooks, MBBS, Cardiology Department, The Royal Melbourne Hospital, Royal Parade Parkville, Melbourne, VIC 3050 (Australia), E-Mail
| | - David A. Pattison
- Department of Endocrinology, The Royal Melbourne Hospital, Melbourne, Vic., Australia
| | - Eliza P. Teo
- Department of Cardiology, The Royal Melbourne Hospital, Melbourne, Vic., Australia
| | - Sarah Price
- Department of Endocrinology, The Royal Melbourne Hospital, Melbourne, Vic., Australia
| | - Ronen Gurvitch
- Department of Cardiology, The Royal Melbourne Hospital, Melbourne, Vic., Australia
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Mansourian AR. A review of literature on the adverse effects of hyperthyroidism on the heart functional behavior. Pak J Biol Sci 2012; 15:164-76. [PMID: 22816174 DOI: 10.3923/pjbs.2012.164.176] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Thyroid hormones play an important role on the physiological chemistry of heart and vascular systems in healthy subjects. Any thyroid disorders accompanied with alteration of effective concentration of thyroid hormones cause heart dysfunctions. Thyrotoxicosis is a term given for the clinical manifestation of hyperthyroidism which can invoke heart and vascular abnormalities through the mechanism at heart muscle cells nuclear level. Thyrotoxicosis can play positive roles for heart disorders including atrial fibrillation, left ventricular hypertrophy and right ventricular systolic dysfunction, which are considered as major risk factors for heart abnormalities. Miscalculation of heart dysfunctions related thyrotoxicosis in cardiovascular patients might be avoided through careful laboratory measurements of T4 and T3 to exclude any possible thyroid hormone-related heart diseases.
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Affiliation(s)
- Azad Reza Mansourian
- Biochemistry and Metabolic Disorder Research Center, Gorgan Medical School, Golestan University of Medical Sciences, Gorgan, Iran
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Butterfield JH. Interferon treatment for hypereosinophilic syndromes and systemic mastocytosis. Acta Haematol 2005; 114:26-40. [PMID: 15995323 DOI: 10.1159/000085560] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Hypereosinophilic syndromes (HES) and systemic mastocytosis (SMCD) are heterogeneous disorders with clinical symptoms from local and remote effects of excessive proliferation of eosinophils and mast cells, respectively. Interferon alpha (IFN-alpha), alone or in combination with other medications, can be a useful, and at times life-saving, treatment for patients with HES. Receptors for IFN-alpha are present on eosinophils, and clinical benefits are due to its effect on eosinophil proliferation, migration, activation, and survival. These effects are likely mediated through multiple pathways including, but not limited to, inhibition of eosinophil colony-forming cells, upregulation of IFN-gamma synthesis, and inhibition of production of eosinophil-active cytokines by T cells, mast cells, and mononuclear cells. IFN-alpha has been life-saving for patients with intractable HES that were resistant to prednisone, hydroxyurea, and other agents. Resistance to the eosinopenic effect of IFN-alpha does not develop and the dose of IFN-alpha necessary to maintain control of eosinophilia often decreases with time. The combination of IFN-alpha and hydroxyurea is very useful and allows dosage reduction of IFN-alpha and better control of hypereosinophilia than with either agent alone. The efficacy of IFN-alpha for treatment of SMCD has been more difficult to establish, with both favorable and unfavorable results reported. The disparate results may have resulted from the small number of patients with SMCD treated with IFN-alpha, the use of various criteria for a "successful" treatment outcome, short duration of treatment and follow-up, and the use of modest dosages. In reported series, side effects from IFN-alpha have frequently been dose-limiting. IFN-alpha improves many of the clinical symptoms of SMCD including dermatological, hematological, gastrointestinal, and systemic symptoms associated with histamine release. IFN-alpha has a beneficial effect on skeletal symptoms because of its ability to increase bone density and reduce painful episodes from vertebral fractures. No consistent improvement in bone marrow infiltration by mast cells has been demonstrated except in a recent study employing high dosages of IFN-alpha. A beneficial effect from the combination of IFN-alpha and prednisone has been reported for several patients, suggesting that combined use of these two medications may provide synergism in treatment outcomes.
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Affiliation(s)
- J H Butterfield
- Divisions of Allergy and Immunology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
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