Rakhshinda Zafar.
A Case Report of Cardiac Manifestations of Thyrotoxicosis.
Biomedica Jan ;14:132-8.

B.B. a 40 years old female was brought to the family from a distant town, at my office in Akram Medical Complex. Patient presented with 1 year history of palpitations, tremors of hands and 7-8 days history of syncopal episodes. She denied symptoms of dyspnea or chest pain. She did not have history of Rheumatic fever in the past. She also denied any family history of sudden cardiac death. She had stopped all medications at the time of presentation, which had been prescribed to her from time to time by various physicians at her home town. She did not report any allergies.

Physical Examination: She was a thinly built female, who was very apprehensive and nervous. Her pulse was 130/min, regular and low volume. BP was 140/80 mmHg, whereas respiratory rate was 18/min. Positive findings in general physical examination included diffusely enlarged thyroid gland, which was smooth in texture and symmetrical. There was no thrill and no bruit was audible. Carotid arteries were palpable bilaterally. No lymphnodes were palpable. There were fine tremors of both hands. Cardiovascular examination revealed PMI (Point of Maximal Impulse) in 5th Intercostal space mid clavicular line. No thrill was palpable. On auscultation 1st heart sound was normal. No extra heart sound was heard and no murmur was audible. Pulmonary examination revealed normal vesicular breath sounds on auscultation. No rales or ronchi were heard. Abdominal examination was unremarkable. Neurological examination was positive for brisk reflexes.

Lab Data: Hb=10.6gm, Hct=32, WBC 7x10E9/L, T3=3.03ng/ml (Normal 0.8-2), T4 > 24.0 mcg/dl (Normal 4.5-12), TSH=0.00 uIU/ml (Normal 0.47-5), ECG=Sinus Tachycardia at 150/min, One mm ST segment depression was present in limb leads II, III and aVF consistent with ischemia; Echocardiogram: Normal study; Ultrasound of thyroid gland showed diffusely enlarged gland. No focal leison was seen.

This patient’s clinical presentation was typical for thyrotoxicosis, most likely secondary to Grave’s Disease. Syncopal attacks are unusual in this condition and other aetiologies such as aortic stenosis or hypertrophic cardiomyopathy, which are more commonly associated with these symptoms, were excluded by physical examination and normal echocardiographic study.

PakMediNet -Pakistan's largest Database of Pakistani Medical Journals - http://www.pakmedinet.com