Thyrotoxic cardiomyopathy and encephalopathy in a paraplegic man.
METHODS
Case report.


OBJECTIVE
Thyrotoxicosis complicating spinal cord injury is more common than generally appreciated. To raise the level of awareness, the following case of fatal thyrotoxicosis is presented.


METHODS
A 77-year-old man, paralyzed at the T12 level for 46 years, developed a sudden 42 lb weight loss, dyspnea, interscapular pain, 120/40 mm Hg blood pressure, a nodular thyroid gland, atrial fibrillation, progressive cardiac enlargement, left ventricular ejection fraction diminishing from 30 to 10% and a persistently low level of thyrotropic hormone, 0.05-0.2 microU ml(-1) (normal 0.35-5.5 microU ml(-1)). As coronary artery bypass grafting had been carried out 6 years earlier and other signs of thyrotoxicosis-exophthalmos, lid lag, sweating, tremor and diarrhea-were absent, recurrent arteriosclerotic heart disease was assumed and a trial of thyroid suppression not attempted. He eventually developed depression and memory loss and died in heart failure after a 4-year course of this illness.


CONCLUSIONS
This case probably represented a toxic multinodular goiter in an elderly paraplegic man with potentially treatable cardiovascular and nervous system complications.
Frisbie
J H
JH
Department of Medicine, Harvard Medical School, Research Service, Boston Healthcare Center and Harvard Medical School, Boston, MA, USA. jfrisbie@comcast.net
D000368:Aged; D001927:Brain Diseases / Q000209:etiology*; D009202:Cardiomyopathies / Q000209:etiology*; D006801:Humans; D008297:Male; D010264:Paraplegia / Q000150:complications*