Thyroid Storm in the Heart: Graves’ Disease Masquerading as Dilated Cardiomyopathy in an Elderly Male

Abstract

Graves’ disease commonly presents with thyroid and extrathyroid manifestations. Cardiovascular manifestations are present in 6% of patients. Only 1% of patients has dilated cardiomyopathy and acute heart failure, which is an unusual presentation of Graves’ disease. An elderly male patient presented with acute heart failure, atrial fibrillation, renal impairment, and secondary to hypotension, diagnosed with dilated cardiomyopathy and significant left ventricular (LV) dysfunction. His test results revealed an increase in T3 and T4 levels with a low thyroid-stimulating hormone (TSH), as well as positive antithyroid antibodies and TSH receptor antibodies, confirming Graves’ disease. The patient improved symptomatically with antiheart failure treatment and antithyroid drugs. On follow-up, his LV dysfunction completely recovered. This instance emphasizes the need of screening heart failure patients to identify reversible causes of heart failure and provide suitable treatment.

Keywords

• acute heart failure
• dilated cardiomyopathy
• graves’ disease