title: Hypothyroidism-induced myocardial damage and heart failure: an overlooked entity.
abstract: BACKGROUND
  Hypothyroid state may induce cardiac muscle impairment such as diastolic dysfunction and abnormal relaxation time. Advanced heart failure in hypothyroid patients has been described only in severe symptomatic cases, mostly during myxedematous coma.
  
  
  RESULTS
  We describe an unusual case of asymptomatic patient with hypothyroidism who presented with severely reduced cardiac function with elevated cardiac enzymes reflecting significant myocardial injury. Comprehensive evaluation for heart failure was suggestive only for long-standing untreated hypothyroidism. Endomyocadial biopsy demonstrated unique histological findings of mucopolysaccharide accumulation attributed to hypothyroid state.
  
  
  CONCLUSIONS
  Asymptomatic hypothyroidism may cause severe reduction in cardiac function accompanied with elevated cardiac enzymes. To our knowledge, this is the first description of human myocardial biopsy revealing mucopolysaccharide accumulation attributed to hypothyroid state.
authors.affiliation: Department of Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel. monysh@gmail.com
authors.forename: Mony
authors.initials: M
authors.lastname: Shuvy
authors.forename: Oshrat E Tayer
authors.initials: OE
authors.lastname: Shifman
authors.forename: Samir
authors.initials: S
authors.lastname: Nusair
authors.forename: Orit
authors.initials: O
authors.lastname: Pappo
authors.forename: Chaim
authors.initials: C
authors.lastname: Lotan
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D001706:Biopsy; D002317:Cardiovascular Agents / Q000627:therapeutic use; D052279:Creatine Kinase, MB Form / Q000097:blood; D004359:Drug Therapy, Combination; D006025:Glycosaminoglycans / Q000032:analysis; D006333:Heart Failure / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology; D006801:Humans; D007037:Hypothyroidism / Q000150:complications* / Q000188:drug therapy / Q000473:pathology / Q000503:physiopathology; D008297:Male; D009206:Myocardium / Q000737:chemistry / Q000473:pathology*; D013974:Thyroxine / Q000627:therapeutic use; D016896:Treatment Outcome; D020107:Troponin T / Q000097:blood; D018487:Ventricular Dysfunction, Left / Q000209:etiology / Q000473:pathology; D018497:Ventricular Dysfunction, Right / Q000209:etiology / Q000473:pathology
chemical_list: D015415:Biomarkers; D002317:Cardiovascular Agents; D006025:Glycosaminoglycans; D020107:Troponin T; D052279:Creatine Kinase, MB Form; D013974:Thyroxine