International Journal of Case Reports and Images - IJCRI - Case Reports, Case Series, Case in Images, Clinical Images

   
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Differential reversibility in heart failure due to hypothyroidism: A series of contrasting cases with review of literature
E. Samuel Roberto1, Thein Aung2, Ajay Agarwal3, Roberto J. Colón4
1M.D., Medical Resident, Wright State University, Boonshoft School of Medicine, Dayton, OH.
2M.D., Cardiovascular Disease Fellow, Wright State University, Boonshoft School of Medicine, Dayton, OH.
3M.D., FACC, Associate Professor of Medicine, Wright State University, Boonshoft School of Medicine; Department of Cardiology, Veteran Affairs Medical Center, Dayton, OH.
4M.D. FACP, Associate Professor of Medicine, Wright State University, Boonshoft School of Medicine, Dayton, OH.

doi:10.5348/ijcri-201601-CS-10062

Address correspondence to:
E. Samuel Roberto
M.D, 1400 Abingdon Rd. Dayton
OH 45409

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How to cite this article
Roberto ES, Aung T, Agarwal A, Colón RJ. Differential reversibility in heart failure due to hypothyroidism: A series of contrasting cases with review of literature. Int J Case Rep Images 2016;7(1):1–6.


Abstract
Introduction: Ranking third as a leading cause of heart failure in the United States, dilated cardiomyopathy (DCMP) affects 5 in 100,00 adults with an eight-year mortality rate between 70–80%. In the setting of hypothyroidism, DCMP is unique due to its potential reversibility with medical therapy. Thyroid hormone affects cardiac physiology and intracellular calcium regulation via SERCA2 and phospholamban, with concentrations of phospholamban most numerous in the ventricles. Administration of thyroid hormone can restore contractile function. However, the relationship between disease timeline and reversibility in DCMP due to hypothyroidism has not been previously described.
Case Series: A 65-year-old Caucasian male presented with new onset severe dyspnea and fatigue. Thyroid-stimulating hormone was markedly elevated. Following levothyroxine therapy, his dilated cardiomyopathy reversed and returned to normal within six months. LVEF improved from 15–45% with decreased chamber dilation. A 60-year-old Caucasian female presented minimally responsive in overt heart failure due to myxedema coma. History revealed chronically uncontrolled hypothyroidism. TSH was significantly elevated. Following prolonged hospitalization and intravenous levothyroxine therapy, her clinical status began to reverse. LVEF improved from 10–25%, with decreased chamber dilation.
Conclusion: Once the underlying mechanism of heart failure was addressed, the cases displayed varying recovery of contractility following thyroid hormone replacement. This may suggest that with longer duration of uncontrolled disease and consequent cardiac structural remodeling, the reversibility diminishes into irreversibility. These cases underscore the need to identify and treat early any contributing hypothyroidism in the setting of new onset dilated cardiomyopathy, as reversibility may be at stake.

Keywords: Dilated cardiomyopathy, Heart failure, Hypothyroidism, Reversibility


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Author Contributions:
Edward Samuel Roberto – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Thein Aung – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Ajay Agarwal – Acquisition of data, Revising it critically for important intellectual content, Final approval of the version to be published
Roberto J. Colon – Acquisition of data, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of submission
The corresponding author is the guarantor of submission.
Source of support
None
Conflict of interest
Authors declare no conflict of interest.
Copyright
© 2016 Edward Samuel Roberto et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.



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