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Rare case of Torsades de Pointes in severe hypothyroidism: literature review and challenges in management

BACKGROUND: Hypothyroidism can manifest as several important cardiac abnormalities. There are few reports of ventricular dysrhythmias (VDs) in hypothyroidism. We described a rare case of VDs in severe hypothyroidism and reviewed the literature behind its management. CASE PRESENTATION: A 67-year-old...

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Autores principales: Lee, Berlin, Lee, Wei Feng, Lim, Beng Leong
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Berlin Heidelberg 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8922778/
https://www.ncbi.nlm.nih.gov/pubmed/35287568
http://dx.doi.org/10.1186/s12245-022-00417-5
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author Lee, Berlin
Lee, Wei Feng
Lim, Beng Leong
author_facet Lee, Berlin
Lee, Wei Feng
Lim, Beng Leong
author_sort Lee, Berlin
collection PubMed
description BACKGROUND: Hypothyroidism can manifest as several important cardiac abnormalities. There are few reports of ventricular dysrhythmias (VDs) in hypothyroidism. We described a rare case of VDs in severe hypothyroidism and reviewed the literature behind its management. CASE PRESENTATION: A 67-year-old gentleman, with poor compliance to treatment for Hashimoto’s thyroiditis, presented with palpitations to the Emergency Department. He had runs of non-sustained ventricular tachycardia (NSVT). He was treated with intravenous (IV) amiodarone and admitted to the intensive care unit for observation. He then developed recurrent Torsades de Pointes (Tdp) despite treatment with several anti-arhythmics. He required electrical cardioversion and eventual transvenous overdrive pacing (OP). VT recurred while he was on OP. VT resolved and he was weaned off OP only after adequate thyroid hormone replacement. CONCLUSIONS: VDs, including NSVT, Tdp, and VT, are rare and potentially lethal in hypothyroidism. Our case demonstrates important challenges in the management of severe hypothyroidism. Here, VDs are often refractory to treatment with drugs and electrical means. The choice(s) of anti-arrhthymics requires careful consideration and can be difficult before thyroid function tests are known. Amiodarone use should be cautioned as it is associated with thyroid dysfunction and QT interval prolongation. There is no literature to guide thyroid hormone replacement in this disease. Aggressive replacement is associated with adverse cardiovascular effects. Our case showed a fine balance between the risk of rapid thyroid hormone replacement and the urgency to terminate VDs. Its administration should be carefully monitored amidst bridging strategies like electrical cardioversion and OP to manage life-threatening VDs.
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spelling pubmed-89227782022-03-22 Rare case of Torsades de Pointes in severe hypothyroidism: literature review and challenges in management Lee, Berlin Lee, Wei Feng Lim, Beng Leong Int J Emerg Med Case Report BACKGROUND: Hypothyroidism can manifest as several important cardiac abnormalities. There are few reports of ventricular dysrhythmias (VDs) in hypothyroidism. We described a rare case of VDs in severe hypothyroidism and reviewed the literature behind its management. CASE PRESENTATION: A 67-year-old gentleman, with poor compliance to treatment for Hashimoto’s thyroiditis, presented with palpitations to the Emergency Department. He had runs of non-sustained ventricular tachycardia (NSVT). He was treated with intravenous (IV) amiodarone and admitted to the intensive care unit for observation. He then developed recurrent Torsades de Pointes (Tdp) despite treatment with several anti-arhythmics. He required electrical cardioversion and eventual transvenous overdrive pacing (OP). VT recurred while he was on OP. VT resolved and he was weaned off OP only after adequate thyroid hormone replacement. CONCLUSIONS: VDs, including NSVT, Tdp, and VT, are rare and potentially lethal in hypothyroidism. Our case demonstrates important challenges in the management of severe hypothyroidism. Here, VDs are often refractory to treatment with drugs and electrical means. The choice(s) of anti-arrhthymics requires careful consideration and can be difficult before thyroid function tests are known. Amiodarone use should be cautioned as it is associated with thyroid dysfunction and QT interval prolongation. There is no literature to guide thyroid hormone replacement in this disease. Aggressive replacement is associated with adverse cardiovascular effects. Our case showed a fine balance between the risk of rapid thyroid hormone replacement and the urgency to terminate VDs. Its administration should be carefully monitored amidst bridging strategies like electrical cardioversion and OP to manage life-threatening VDs. Springer Berlin Heidelberg 2022-03-14 /pmc/articles/PMC8922778/ /pubmed/35287568 http://dx.doi.org/10.1186/s12245-022-00417-5 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Case Report
Lee, Berlin
Lee, Wei Feng
Lim, Beng Leong
Rare case of Torsades de Pointes in severe hypothyroidism: literature review and challenges in management
title Rare case of Torsades de Pointes in severe hypothyroidism: literature review and challenges in management
title_full Rare case of Torsades de Pointes in severe hypothyroidism: literature review and challenges in management
title_fullStr Rare case of Torsades de Pointes in severe hypothyroidism: literature review and challenges in management
title_full_unstemmed Rare case of Torsades de Pointes in severe hypothyroidism: literature review and challenges in management
title_short Rare case of Torsades de Pointes in severe hypothyroidism: literature review and challenges in management
title_sort rare case of torsades de pointes in severe hypothyroidism: literature review and challenges in management
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8922778/
https://www.ncbi.nlm.nih.gov/pubmed/35287568
http://dx.doi.org/10.1186/s12245-022-00417-5
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