title: Takotsubo cardiomyopathy associated with thyrotoxicosis: a case report and review of the literature.
abstract: BACKGROUND
  Takotsubo or stress-induced cardiomyopathy is a form of reversible cardiomyopathy commonly associated with emotional or physical stress. Thyrotoxicosis has been identified as a rare cause of Takotsubo cardiomyopathy, with only 12 cases reported in the literature. Here, we report a case of thyroid storm presenting with Takotsubo cardiomyopathy in the setting of Graves' disease.
  
  
  METHODS
  A 71-year-old woman presented with abdominal pain, vomiting, confusion, and history of weight loss. She was initially diagnosed and treated for diabetic ketoacidosis at another hospital and was transferred to our hospital one day after initial presentation because of concern for acute coronary syndrome. A diagnosis of Takotsubo cardiomyopathy was made on the basis of cardiac catheterization. At that time, she was diagnosed and treated for thyroid storm. Follow-up 7 weeks later revealed improvement of her cardiac function and near-normalization of thyroid hormone levels.
  
  
  CONCLUSIONS
  In this patient, who presented with symptoms of heart failure, acute coronary syndrome was initially considered, but the diagnosis of Takotsubo cardiomyopathy associated with thyroid storm was ultimately made based on cardiac catheterization and laboratory investigation.
  
  
  CONCLUSIONS
  Thyrotoxicosis is associated with adverse disturbances in the cardiovascular system. Takotsubo cardiomyopathy could be a presenting manifestation of thyroid storm, perhaps related to excess catecholamine levels or sensitivity.
authors.affiliation: 1 Department of Internal Medicine, Medstar Washington Hospital Center , Washington, District of Columbia.
authors.forename: Myrto
authors.initials: M
authors.lastname: Eliades
authors.forename: Diala
authors.initials: D
authors.lastname: El-Maouche
authors.forename: Chitra
authors.initials: C
authors.lastname: Choudhary
authors.forename: Bruce
authors.initials: B
authors.lastname: Zinsmeister
authors.forename: Kenneth D
authors.initials: KD
authors.lastname: Burman
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis; D000368:Aged; D003937:Diagnosis, Differential; D005260:Female; D006111:Graves Disease / Q000150:complications*; D006801:Humans; D054549:Takotsubo Cardiomyopathy / Q000175:diagnosis / Q000209:etiology*; D013958:Thyroid Crisis / Q000150:complications* / Q000175:diagnosis
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