Complete Recovery of Thyrotoxicosis Cardiomyopathy After Antithyroid and Corticosteroid Therapy: A Case Report
Keywords:
Thyrotoxicosis, Heart Failure, Dilated Cardiomyopathy, Antithyroid, Case ReportAbstract
Thyroid storm (TS) is an extreme hypermetabolic state due to thyrotoxicosis. TS may manifest as cardiovascular symptoms, including atrial fibrillation (AF) (9 – 23%) and heart failure (HF). Dilated cardiomyopathy (DCM) and HF develop at a later stage in approximately 1% of thyrotoxicosis patients. A 46-year-old man presented to the emergency department with a chief complaint of severe dyspnea and rapid AF. Blood test examination showed overt thyrotoxicosis. The Burch-Wartofsky point scale is 60 (highly suggestive of TS). Echocardiography showed severely reduced left ventricular (LV) systolic function. The patient was diagnosed with TS, rapid AF with DCM, probably due to thyrotoxic cardiomyopathy. After 3 months of antithyroid therapy, corticosteroids, and optimal HF management, we observed complete recovery of his ventricular function, along with spontaneous conversion to sinus rhythm. LV systolic dysfunction is described in a small percentage of thyrotoxicosis patients. In later stages of thyrotoxicosis cardiomyopathy (TCM), HF phenotype of DCM will develop, characterized by progressive reduction of myocardial systolic function that marks advanced stages of TCM. This report highlighted the importance of thyroid investigation as an integral part of HF etiological work-up due to its reversibility.References
Taylor GM, Pop AMC, McDowell EL. High-output congestive heart failure: a potentially deadly complication of thyroid storm. Oxf Med Case Reports. 2019 June;2019(6):omz045.
Quiroz-Aldave JE, Durand-Vásquez MDC, Lobato-Jeri CJ, Muñoz-Moreno JM, Deutz Gómez Condori DC, Ildefonso-Najarro SP, et al. Thyrotoxic Cardiomyopathy: State of the Art. touchREV Endocrinol. 2023 May;19(1):78–84.
Khan R, Sikanderkhel S, Gui J, Adeniyi AR, O’Dell K, Erickson M, et al. Thyroid and Cardiovascular Disease: A Focused Review on the Impact of Hyperthyroidism in Heart Failure. Cardiol Res. 2020 Apr;11(2):68–75.
Heidenreich PA, Bozkurt B, Aguilar D, et al. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2022 May 3;145(18):e895–1032.
McDonagh TA, Metra M, Adamo M, et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021 Sept 21;42(36):3599–726.
Pokhrel B, Aiman W, Bhusal K. Thyroid storm. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 [cited 2026 Jan 14]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK448095/
Martinez F. Thyroid hormones and heart failure. Heart Fail Rev. 2016 July;21(4):361–4.
Noor YA, Mulia EPB, Prajitno JH. Thyrotoxic heart failure: A narrative review of pathophysiology and principal management. 2021.
Waqar Z, Avula S, Shah J, Ali SS. Cardiovascular events in patients with thyroid storm. J Endocr Soc. 2021 Mar 11;5(6):bvab040.
Osuna PM, Udovcic M, Sharma MD. Hyperthyroidism and the heart. Methodist Debakey Cardiovasc J. 2017;13(2):60–3.
El-Menyar A, Khan NA, Elmenyar E, et al. Thyroid storm-induced cardiovascular complications and modalities of therapy: Up-to-date review. World J Crit Care Med. 2025 Dec 9;14(4):109565.
Shi R, Meng W, Yin J, Xue W, Deng Y. Reversible acute heart failure induced by thyrotoxic cardiomyopathy: A case report. Medicine (Baltimore). 2024 May 24;103(21):e38305.
Khalil Y, Dube MD, Woods L. Thyrotoxicosis-induced cardiomyopathy with systolic dysfunction. Cureus. 15(1):e33988.
Molinaro G, Vecchis RD, Badolati E, Giannattasio R. Thyrotoxic dilated cardiomyopathy: personal experience and case collection from the literature. Endocrinology, Diabetes & Metabolism Case Reports [Internet]. 2020 Dec 24 [cited 2026 Jan 13];2020(1). Available from: https://edm.bioscientifica.com/view/journals/edm/2020/1/EDM20-0068.xml
Lorlowhakarn K, Kitphati S, Songngerndee V, et al. Thyrotoxicosis-induced cardiomyopathy complicated by refractory cardiogenic shock rescued by extracorporeal membrane oxygenation. Am J Case Rep. 2022 Jan 25;23.
Fotso Simo SC, Lin KS, Bukharovich I. Thyrotoxic cardiomyopathy: A rare case of thyroid storm presenting as De Novo heart failure. Cureus. 16(4):e57924.
Rodríguez-Santiago MA, Mesa-Pabón MA. Managing thyrotoxicosis in acute heart failure. JACC: Case Reports. 2025 July 9;30(18):103935.
Satoh T, Isozaki O, Suzuki A, et al. 2016 Guidelines for the management of thyroid storm from The Japan Thyroid Association and Japan Endocrine Society (First edition). Endocr J. 2016 Dec 30;63(12):1025–64.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Kyra Adiavira, Mochamad Rizky Hendiperdana, Siti Untari Subekti, Rarsari Soerarso
This work is licensed under a Creative Commons Attribution 4.0 International License.
Copyright
The authors who publish in this journal agree to the following requirements:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0) that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors can enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) before and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work. (See The Effect of Open Access)
Privacy Statement
The names and email addresses entered in this journal site will be used exclusively for the stated purposes of this journal and will not be made available for any other purpose or to any other party.
