Hypothyroidism-induced myocardial damage and heart failure: an overlooked entity.
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.
Shuvy
Mony
M
Department of Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel. monysh@gmail.com
Shifman
Oshrat E Tayer
OE
Nusair
Samir
S
Pappo
Orit
O
Lotan
Chaim
C
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
D015415:Biomarkers; D002317:Cardiovascular Agents; D006025:Glycosaminoglycans; D020107:Troponin T; D052279:Creatine Kinase, MB Form; D013974:Thyroxine