title: T-wave inversions on ECG as primary manifestation of Hashimoto's disease.
abstract: A middle-aged Hispanic woman presented to the emergency department (ED) reporting of acute new onset pressure-like chest pain developed at rest. It was radiated to the right arm and associated with malaise. Initial ECG demonstrated T-wave inversions (TWIs) in all anterior and lateral leads. Electrolytes, serial cardiac troponin and D-dimer were all normal. Comprehensive transthoracic echocardiogram and nuclear stress test did not reveal a cardiac cause of her symptoms.Serum thyroid-stimulating hormone was markedly elevated (207 mIU/L) and free thyroxine was low (FT4 0.07 ng/dL), consistent with severe primary hypothyroidism. Thyroperoxidase (TPO) antibodies were positive. Therapy with levothyroxine was started. No other cause of the TWIs was identified. A repeat ECG obtained 8 weeks later showed partial resolution of the TWIs. Our observations indicate that Hashimoto's disease is the most likely primary cause of this patient's extensive and profound TWI, which improved after thyroid replacement therapy.
authors.affiliation: Department of Internal Medicine, Bridgeport Hospital - Yale New Haven Health, Bridgeport, Connecticut, USA.
authors.forename: Katherine A
authors.initials: KA
authors.lastname: Araque
authors.affiliation: Department of Internal Medicine, Bridgeport Hospital - Yale New Haven Health, Bridgeport, Connecticut, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Smith
authors.affiliation: Department of Emergency Department, Bridgeport Hospital - Yale New Haven Health, Bridgeport, Connecticut, USA.
authors.forename: Brooks M
authors.initials: BM
authors.lastname: Walsh
mesh_terms: D000328:Adult; D004562:Electrocardiography; D005260:Female; D050031:Hashimoto Disease / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology*; D006334:Heart Function Tests; D006801:Humans; D013974:Thyroxine / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D013974:Thyroxine