Unusual presentation of thyrotoxicosis as complete heart block and renal failure: a case report
Suresh Krishnamoorthy, Rajay Narain, John Creamer
City Hospital, Sandwell and West Birmingham Hospitals, NHS Trust, Birmingham, B18 7QH, UK; University Hospitals of North Staffordshire, Stoke on Trent, ST4 6QG, UK
In this presentation we discuss the case of a 59-year-old Caucasian man admitted with weight loss, lethargy, abnormal liver function, renal failure and complete heart block due to thyrotoxicosis.
Full Description
Introduction: Thyrotoxicosis is a clinical entity often very difficult to diagnose without biochemical confirmation as its clinical features can be highly varied. The most common cardiac manifestations of thyrotoxicosis are resting sinus tachycardia, supraventricular tachycardia including atrial fibrillation and atrial flutter with or without cardiac failure. Bradycardia and atrio-ventricular conduction defects are very uncommon in thyrotoxicosis.
Case presentation: We report the case of a 59-year-old Caucasian man presenting with progressive weight loss, abnormal liver function, acute renal failure and complete heart block due to thyrotoxicosis.
Conclusion: Thyrotoxicosis should be considered as a possible diagnosis in patients with bradycardia and heart blocks associated with abnormal symptoms like weight loss. Nevertheless, the clinical, electrophysiological and biochemical abnormalities associated with thyrotoxicosis may be completely reversible restoring euthyroid state.
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[1] Rives JD, Shepard RM: Thyroid crisis. Am Surg 1951, 17:406-418.
[2] Valcavi R, Menozzi C, Roti E, Zini M, Lolli G, Roti S, Guiducci U, Portioli I: Sinus node function in hyperthyroid patients. J Clin Endocrinol Metab 1992, 75(1):239-242.
[3] Kramer MR, Shilo S, Hershko C: Atrioventricular and sinoatrial block in thyrotoxic crisis. Br Heart J 1985, 54(6):600-602.
[4] Miller RH, Corcoran FH, Baker WP: Second and third degree atrioventricular block with Graves' disease: a case report and review of the literature. Pacing Clin Electrophysiol 1980, 3(6):702-711.
[5] Topaloglu S, Topaloglu OY, Ozdemir O, Soylu M, Demir AD, Korkmaz S: Hyperthyroidism and complete atrioventricular block--a report of 2 cases with electrophysiologic assessment. Angiology 2005, 56(2):217-220.
[6] Sataline L, Donaghue G: Hypercalcemia, heart block, and hyperthyroidism. JAMA 1970, 213:1342.
[7] Ortmann C, Pfeiffer H, Du Chesne A, Brinkmann B: Inflammation of the cardiac conduction system in a case of hyperthyroidism. Int J Legal Med 1999, 112(4):271-274.
[8] Shirani J, Barron MM, Pierre-Louis ML, Roberts WC: Congestive heart failure, dilated cardiac ventricles, and sudden death in hyperthyroidism. Am J Cardiol 1993, 72:365-368.
[9] Osman F, Ayuk J, Dale J, Franklyn JA: Gammage MD: Thyrotoxicosis with heart block. J R Soc Med 2001, 94(7):346-348.
[10] Marti V, Ballester M, Obrador D, Moya C, Carrio I, Pons-Llado G: Active myocardial damage in hyperthyroidism; a concurrent mechanism of heart failure reversed by treatment. Eur Heart J 1995, 16:1014-1016.
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