Levothyroxine sodium
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Takotsubo cardiomyopathy due to hyperthyroidism: case report A 60-year-old man developed takotsubo cardiomyopathy due to hyperthyroidism during treatment with levothyroxine sodium for hypothyroidism. The man, who had been diagnosed with hypothyroidism 10 years ago, had been receiving levothyroxine sodium 100 µg/day [route not stated]. He presented with dyspnea and increased anxiety. An initial physical examination revealed sinus tachycardia and generalized pulmonary hypoventilation. Chest X-ray revealed signs of mild fluid overload and vascular redistribution. At the emergency room, he experienced a sudden episode of tachypnea, respiratory worsening and desaturation. An ECG showed flattened T-waves in V2 and V3 and shallow inverted symmetric T-waves in precordial. A transthoracic echocardiogram showed akinesia of the apex and medio-distal segments of all faces with hyperkinesia and severely depressed left ventricular ejection fraction (LVEF). Blood test showed leucocytosis with neutrophilia, Nt-proBNP of 12788 ng/L and troponin-I of 429 ng/L. The woman was treated with spironolactone, furosemide and captopril. After 24 hours of the onset, a follow-up echocardiogram showed normalization of LVEF, and troponin-I was improved to 60 ng/L. He was diagnosed with stress cardiomyopathy. Thyroid hormone analyses showed an elevated T4 with suppressed TSH. He was hospitalised. Levothyroxine sodium was discontinued until the normalisation of the thyroid profile. At two months follow-up, his evolution was favorable, without any cardiomyopathy. Cervilla-Munoz E, et al. Iatrogenic hyperthyroidism can be a triggering factor for takotsubo cardiomyopathy. Medicina Clinica 155: 42-43, No. 1, 10 Jul 2020. Available 803499995 from: URL: http://doi.org/10.1016/j.medcli.2019.02.014
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Reactions 5 Sep 2020 No. 1820
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