Severe reversible dilated cardiomyopathy and hyperthyroidism: case report and review of the literature.
OBJECTIVE
To describe a case of a 46-year-old woman with Graves' disease and reversible low-output congestive heart failure and present a comparative analysis of 23 similar cases reported in the literature.


METHODS
A detailed case report is presented. In addition, a review of the pertinent literature published between 1960 and 2002 was performed to identify similar cases of dilated cardiomyopathy and thyrotoxicosis and to assess the findings in these patients.


RESULTS
A 46-year-old woman without primary heart disease was admitted to the hospital with Graves' thyrotoxicosis and severe low-output congestive heart failure. Her left ventricular ejection fraction (LVEF) at the time of initial assessment was less than 20%, and her condition was categorized as New York Heart Association (NYHA) functional class III. Nineteen months after she was treated for hyperthyroidism, her LVEF was 49% and her status was NYHA class I. A severe hypotensive episode occurred when b-adrenergic blockade therapy was initiated. The group of 23 similar cases from the literature plus our currently described patient had a mean age of 45 years, a male-to-female ratio of 1:1.2, Graves' disease as the principal cause, and LVEF improvement from 29% to 58%.


CONCLUSIONS
Dilated cardiomyopathy is an unusual manifestation of hyperthyroidism with unclear cause. Clinicians should be aware of this entity because it is treatable and hypotension can occur if b-adrenergic blockade treatment is initiated.
Boccalandro
Cristina
C
Division of Endocrinology and Metabolism, University of Texas at Houston, Houston, Texas, USA.
Boccalandro
Fernando
F
Orlander
Philip
P
Wei
Chik Fong
CF
D000319:Adrenergic beta-Antagonists / Q000009:adverse effects; D002302:Cardiac Output; D002311:Cardiomyopathy, Dilated / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology; D005260:Female; D006801:Humans; D006980:Hyperthyroidism / Q000150:complications*; D007022:Hypotension / Q000139:chemically induced / Q000503:physiopathology / Q000628:therapy; D008875:Middle Aged
D000319:Adrenergic beta-Antagonists