“Increased Myocardial Wall Thickness in a Patient with Severe Hypothyroidism, Showed Complete Reversibility After Thyroid Hormone Replacement Therapy” Case Report and Literature Review
Main Article Content
Abstract
Introduction:
Hypothyroidism affects the cardiovascular system in various ways. This may include bradycardia, diastolic hypertension, increased systemic vascular resistance (SVR), decreased cardiac contractility, and cardiac output. Increased myocardial thickness is seldomly reported. The thickness can be secondary to edema, hypertrophy, substance deposition, or the combination of all three.
Case summary:
In this case report and review we present a patient with severe hypothyroidism and massive recurrent pericardial effusion, leading to cardiac tamponade that needed drainage twice at one-month intervals. Increased myocardial wall thickness of both the septum and the posterior walls was detected. The increased thickness completely recovered in six months duration after thyroid hormone replacement and restoration of euthyroid status. We ran a review on the effects of hypothyroidism on the heart and vascular system, with a focus on the incidence, possible etiology, and reversibility of increased tissue thickness in different body organs in hypothyroid patients. These organs are the skin, the myocardium, and the carotid intima.
Conclusion:
Severe hypothyroidism can cause increased myocardial thickness that is reversible after thyroid hormone replacement therapy. Increased thickness is also seen in the skin and the carotid intima. The pathophysiology is probable of various etiology, however myocardial edema seems to be a strong reason considering the quick recovery after treatment.
Keywords:
Case report, Hypothyroidism, Myocardial thickness, Pericardial effusion, Carotid intimal thickness
Article Details
How to Cite
TAYEB, Dr. Areeg Magzoub Babiker El et al.
“Increased Myocardial Wall Thickness in a Patient with Severe Hypothyroidism, Showed Complete Reversibility After Thyroid Hormone Replacement Therapy” Case Report and Literature Review.
Medical Research Archives, [S.l.], v. 12, n. 12, dec. 2024.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/6095>. Date accessed: 06 jan. 2025.
doi: https://doi.org/10.18103/mra.v12i12.6095.
Section
Case Reports
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
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(2) Jamwal A, Sharma A, Rather PA. original article. Cutaneous Manifestations of Hypothyroidism: Prospective Hospital Based Clinical Study. J Adv Med Dent Scie 2013;1(2):5-12.
(3) Kahaly GJ, Dillmann WH. Thyroid hormone action in the heart. Endocrine Rev. 2005; 26:704–728.
(4) Biondi B, Palmieri EA, Lombardi G, et al. Effects of thyroid hormone on cardiac function: the relative importance of heart rate, loading conditions, and myocardial contractility in the regulation of cardiac performance in human hyperthyroidism. J Clin Endocrinol Metab. 2002; 87:968–974.
(5) Ramesh K, Nayak B, Balaji Prasad Nayak. A study of cardiovascular involvement in Hypothyroidism. IAIM. 2016;3(5):74-80. https://www.iaimjournal.com/storage/2016/05/iaim_2016_0305_12.pdf
(6) Brent GA, Epstein FH. The molecular basis of thyroid hormone action. N Engl J Med. 1994; 331(13):847-853.
doi: https://doi.org/10.1056/nejm199409293311306
(7) Danzi S, Dubon P, Klein I. Effect of serum T3 on the regulation of cardiac gene expression: role of histone acetylation. Am J Physiol Heart Circ Physiol. 2005; 289:1506-1511.
(8) Mintz G, Pizzarello R, Klein I. Enhanced left ventricular diastolic function in hyperthyroidism: noninvasive assessment and response to treatment. J Clin Endocrinol Metab. 1991; 73:146–150.
(9) Hiroi Y, Kim H-H, Ying H, et al. Rapid nongenomic actions of thyroid hormone. Proc Natl Acad Sci U SA. 2006; 103:14104–14109.
(10) Udovcic M, Pena RH, Patham B, et al. Hypothyroidism and the Heart. Methodist DeBakey Cardiovascular Journal. 2017;13(2):55-59. doi: https://doi.org/10.14797/mdcj-13-2-55
(11) Hajje G, Saliba Y, Itani T, et al. Hypothyroidism and its rapid correction alter cardiac remodeling. PLoS One. 2014 Oct 15;9(10): e109753. doi: 10.1 371/journal.pone.0109753. PMID: 25333636; PMCID: PMC4198123.
(12) Cappola AR, Ladenson PW. Hypothyroidism and atherosclerosis. J Clin Endocrinol Metab. 2003; 88:2438–2444.
(13) Qureshi AI, Suri FK, Nasar A, et al. Free thyroxine index and risk of stroke: results from the National Health and Nutrition Examination Survey Follow-up Study. Med Sci Monit. 2006; 12:CR501–CR506.
(14) Palmieri EA, Fazio S, Lombardi G, et al. Subclinical hypothyroidism and cardiovascular risk: a reason to treat. Treat Endocrinol. 2004; 3:233–244.
(15) Klein I, Danzi S. Thyroid Disease, and the Heart. Circulation. 2007;116(15):1725-1735.
doi: https://doi.org/10.1161/circulationaha.106.678326
(16) Dorr M, Wolff B, Robinson DM, et al. The association of thyroid function with cardiac mass and left ventricular hypertrophy. J Clin Endocrinol Metab. 2005; 90:673–677.
(17) Rawat B, Satyal A. An echocardiographic study of cardiac changes in hypothyroidism and the response to treatment. Kathmandu University Medical Journal, 2003; 2(7): 182-187.
(18) Cianciulli TF, Morita LA, Saccheri MC, et al. Hypothyroid cardiomyopathy: A reversible phenocopy of hypertrophic cardiomyopathy. Echocardiography. 2021 Sep;38(9):1673-1677. doi: 10.1111/echo.15 183. Epub 2021 Sep 12. PMID: 34510529.
(19) Pastor Quirante FA, Pastor-Pérez FJ, Manzano-Fernández S, et al. Un expected autopsy findings after sudden cardiac death: Cardiovascular myxoedema and endocardial fibroelastosis. International Journal of Cardiology. 2015; 182:281-283. doi: https://doi.org/10.1016/j.ijcard.2014.12.156
(20) Gao x, Liu M, Qu A, et al. Native Magnetic Resonance T1 mapping identifies Diffuse Myocardial Injury in Hypothyroidism. 2016, Mar. PLOS one. 10;11(3): e0151266. Doi: 10.1371/journal. pone. 0151266
(21) Forfar JC, Muir AL, Toff AD. Left ventricular function in hypothyroidism. Br Heart J., 1982; 48: 278-284.
(22) Klein I, Ojamaa K. Thyroid hormone and the cardiovascular system. N Engl J Med. 2001; 344: 501–509.
(23) Dillmann WH. Cellular action of thyroid hormone on the heart. Thyroid. 2002; 12:447–452.
(24) Scarbottolo L, Trezze E, Roma P et al. Experimental hypothyroidism modulates the expression of the low-density lipoprotein receptor by the liver. Atherosclerosis, 1986; 59:329–33.
(25) Mayer O, Šimon J, Filipovský J, et al. Hypothyroidism in coronary heart disease and its relation to selected risk factors. Vascular Health and Risk Management. 2006;2(4):499-506. doi: https://doi.org/10.2147/vhrm.2006.2.4.499
(26) Rush J, Danzi S, Klein I. Role of thyroid disease in the development of statin-induced myopathy. The Endocrinologist. 2006; 16:279–285.
(27) Hak AE, Pols HA, Visser TJ, et al. Subclinical hypothyroidism is an independent risk factor for atherosclerosis and myocardial infarction in elderly women: the Rotterdam Study. Ann Intern Med. 2000; 132:270–278.
(28) Schmidt-Ott UM, Ascheim DD. Thyroid hormone and heart failure. Curr Heart Fail Rep. 2006; 3:114–119.
(29) Pingitore A, Landi P, Taddei MC, et al. Triiodothyronine levels for risk stratification of patients with chronic heart failure. Am J Med. 2005; 118:132–136.
(30) Inoue K, Guo R, Lee ML, et al. Iodine- Induced Hypothyroidism and Long-Term Risks of Incident of Heart Failure. J Am Heart Assoc. 2023; 12: e030511. DOI: 10.1161/JAHA.123.030511
(31) Li JH, Safford RE, Aduen JF, et al. Pulmonary hypertension and thyroid disease. Chest. 2007; 132(3):793–7.
(32) Vakilian F, Attaran D, Shegofte M, et al. Assessment of thyroid function in idiopathic pulmonary hypertension. Res Cardiovasc Med. 2016; 5(2): e29361.
(33) Ghio S, Gavazzi A, Campana C, et al. Independent and additive prognostic value of right ventricular systolic function and pulmonary artery pressure in patients with chronic heart failure. J Am Coll Cardiol. 2001;37(1):183–8.
(34) Ripoli A, Pingitore A, Favilli B, et al. Does subclinical hypothyroidism affect cardiac pump performance? Evidence from a magnetic resonance imaging study. J Am Coll Cardiol. 2005;45(3):439–45.
(35) Yang G, Wang Y, Ma A, et al. Subclinical thyroid dysfunction is associated with adverse prognosis in heart failure patients with reduced ejection fraction. BMC Cardiovascular Disorders (2019). https://doi.org/10.1186/s12872-019-1055-x
(36) Tang YD, Kuzman JA, Said S, et al. Low thyroid function leads to cardiac atrophy with chamber dilatation, impaired myocardial blood flow, loss of arterioles, and severe systolic dysfunction. Circulation. 2005 Nov 15;112(20):3122-30. doi: 10.1161/CIRCULATIONAHA.105.572883. Epub 2005 Nov 7. PMID: 16275864.
(37) Napoli R, Biondi B, Guardasole V, et al. Impact of hyperthyroidism and its correction on vascular reactivity in humans. Circulation. 2001; 104:3076–3080.
(38) Taddei S, Caraccio N, Virdis A, et al. Impaired endothelium-dependent vasodilatation in subclinical hypothyroidism: beneficial effect of levo thyroxine therapy. J Clin Endocrinol Metab. 2003; 88:3731–3737.
(39) Schoenmakers N, de Graaff WE, Peters RH. Hypothyroidism as the cause of atrioventricular block in an elderly patient. Neth Heart J 2008; 16:57–9.
(40) Mangiardi L, Gaita F, Brun S, et al. Atrioventricular block complicating amiodarone-induced hypothyroidism in a patient with pre-excitation and rate-dependent bilateral bundle branch block. J Am Coll Cardiol 1986; 7:180–4.
(41) Nakayama Y, Ohno M, Yonemura S, et al. A case of transient 2:1 atrioventricular block, resolved by thyroxine supplementation for subclinical hypothyroidism. Pacing Clin Elec trophysiol 2006; 29:106–8.
(42) Singh JB, Starobin OE, Guerrant RL, et al. Reversible atrioventricular block in myxedema. Chest 1973; 63:582–5.
(43) Ozcan K.S, Osmonov D, Erdinler I, et al. Atrioventricular block in patients with thyroid dysfunction: Prognosis after treatment with hormone supplementation or antithyroid medication. Journal of Cardiology 60 (2012) 327–332
(44) Harjai KJ, Licata AA. Effects of amiodarone on thyroid function. Ann Intern Med. 2006; 126:63–73.
(45) Martino E, Bartalena L, Bogazzi F, et al. The effects of amiodarone on the thyroid. Endocr Rev. 2001; 22:240–254.
(46) Bogazzi F, Bartalena L, Tomisti L, et al. Glucocorticoid response in amiodarone induced thyrotoxicosis resulting from destructive thyroiditis is predicted by thyroid volume and serum free thyroid hormone concentrations. J Clin Endocrinol Metab. 2007; 92:556–562.
(47) Klein I, Ojamaa K. Thyroid hormone and the cardiovascular system. N Engl J Med. 2001; 344: 501–509.
(48) Surks MI, Ortiz E, Daniels GH, et al. Subclinical thyroid disease: scientific review and guidelines for diagnosis and management. JAMA. 2004; 291:228–238.
(49) Rodondi N, den Elzen WP, Bauer DC, et al. Subclinical hypothyroidism and the risk of coronary heart disease and mortality. JAMA. 2010; 304:1 365–1374.
(50) Rodondi N, Bauer DC, Cappola AR, et al. Subclinical thyroid dysfunction, cardiac function, and the risk of heart failure: the Cardiovascular Health Study. J Am Coll Cardiol. 2008; 52:1152–1159.
(51) Galli E, Pingitore A, Iervasi G. The role of thyroid hormone in the pathophysiology of heart failure: clinical evidence. Heart Fail Rev. 2010; 15: 155–169.
(52) Rodondi N, Aujesky D, Vittinghoff E, et al. Subclinical hypothyroidism, and the risk of coronary heart disease: a meta-analysis. Am J Med. 2006; 119:541–551.
(53) Rodondi N, Newman AB, Vittinghoff E, et al. Subclinical hypothyroidism and the risk of heart failure, other cardiovascular events, and death. Arch Intern Med. 2005 Nov 28;165(21):2460-6. doi: 10.1001/archinte.165.21.2460. PMID: 16314541.
(54) Razvi S, Ingoe L, Keeka G, et al. The beneficial effect of L-thyroxine on cardiovascular risk factors, endothe lial function and quality of life in subclinical hypothyroidism: ran domised, crossover trial. J Clin Endocrinol Metab. 2007; 92:1715–1723.
(55) Adrees M, Gibney J, El-Saeity N, et al. Effects of 18 months of L-T4 replacement in women with subclinical hypothyroidism. Clin Endocrinol (Oxf). 2009 Aug;71(2):298-303.
(56) O'Leary DH, Polak JF. Intima-media thickness: a tool for atherosclerosis imaging and event prediction. Am J Cardiol 2002; 90:18l–21
(57) Gao N, Zhang W, Zhang YZ, et al. Carotid intima-media thickness in patients with subclinical hypothyroidism: a meta-analysis. Atherosclerosis 2013; 227:18–25.
58) Wang JG, Staessen JA, Li Y, et al. Carotid intima-media thickness, and antihypertensive treatment: a meta-analysis of randomized controlled trials. Stroke 2006; 37:1933–40.
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