title: Cardiomyopathy associated with Graves' disease.
abstract: Cardiovascular changes associated with Graves' disease are generally considered to be secondary to the increased levels of thyroid hormone. We describe a case of Graves' disease in a 25-year-old man, who developed cardiomyopathy with severe heart failure. Pathological examination of the myocardial biopsies showed fibroblast infiltration and degenerative changes. After the cardiomyopathy subsided the patient developed a goitre and signs of hyperthyroidism, followed by Graves' ophthalmopathy, which was treated successfully with a combination of high-dose corticosteroids and orbital radiotherapy. These findings suggested a common pathogenesis for the cardiomyopathy and ophthalmopathy, and prompted us to investigate the expression of TSH receptor (TSH-R) in human heart. TSH-R mRNA was identified in human heart using the reverse transcriptasepolymerase chain reaction (RT-PCR) and DNA sequencing. Taken together, these data suggest that autoimmunity against the TSH-R might contribute to both the cardiomyopathy and ophthalmopathy in similar cases of Graves' disease.
authors.affiliation: Department of Internal Medicine, Hyogo Prefectural Amagasaki Hospital, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Koshiyama
authors.forename: D F
authors.initials: DF
authors.lastname: Sellitti
authors.forename: T
authors.initials: T
authors.lastname: Akamizu
authors.forename: S Q
authors.initials: SQ
authors.lastname: Doi
authors.forename: Y
authors.initials: Y
authors.lastname: Takeuchi
authors.forename: D
authors.initials: D
authors.lastname: Inoue
authors.forename: H
authors.initials: H
authors.lastname: Sakaguchi
authors.forename: G
authors.initials: G
authors.lastname: Takemura
authors.forename: Y
authors.initials: Y
authors.lastname: Sato
authors.forename: Y
authors.initials: Y
authors.lastname: Takatsu
authors.forename: K
authors.initials: K
authors.lastname: Nakao
mesh_terms: D000328:Adult; D001483:Base Sequence; D009202:Cardiomyopathies / Q000209:etiology* / Q000378:metabolism; D017931:DNA Primers / Q000235:genetics; D006111:Graves Disease / Q000150:complications* / Q000378:metabolism; D006801:Humans; D008297:Male; D008969:Molecular Sequence Data; D009206:Myocardium / Q000378:metabolism; D016133:Polymerase Chain Reaction; D012333:RNA, Messenger / Q000032:analysis; D011989:Receptors, Thyrotropin / Q000235:genetics / Q000378:metabolism*; D017422:Sequence Analysis, DNA
chemical_list: D017931:DNA Primers; D012333:RNA, Messenger; D011989:Receptors, Thyrotropin