Thyroid dysfunction and takotsubo cardiomyopathy: a narrative review

Document Type : review article

Authors

Seyed-Al-Shohada Cardiology Hospital, Urmia University of Medical Sciences, Urmia, Iran

Abstract

Objectives: Takotsubo cardiomyopathy (TCM) is a transient left ventricular wall motion abnormality commonly following physical and emotional stress that can be resolved entirely. Recent case reports and some case-control studies have suggested a likely close association between thyrotoxicosis and TCM. It was shown that resolving thyroid functional status led to resolving TCM symptoms leading to normal cardiac function without a significant sequela, emphasizing a triggering role of thyrotoxicosis for flaring TCM. Here, the literature on the association between thyroid dysfunction and the likelihood of TCM is reviewed to describe the likely pathophysiology of TCM associated with thyroid dysfunction.

Keywords


1.Chae YK, Chiec L, Adney SK, et al. Posterior reversible encephalopathy syndrome and takotsubo cardiomyopathy associated with lenvatinib therapy for thyroid cancer: a case report and review. Oncotarget. 2018;9(46):28281-28289.
2.Maron BJ, Towbin JA, Thiene G, et al. Contemporary definitions and classification of the cardiomyopathies: an American Heart Association scientific statement from the council on clinical cardiology, heart failure and transplantation committee; quality of care and outcomes research and functional genomics and translational biology interdisciplinary working groups; and council on epidemiology and prevention. Circulation. 2006;113(14):1807-16.
3.Khatiwada S, Boro H, Farooqui FA, et al. Endocrine causes of heart failure: A clinical primer for Cardiologists. Indian Heart J. 2021;73(1):14-21.
4.Eshtehardi P, Koestner SC, Adorjan P, et al. Transient apical ballooning syndrome—clinical characteristics, ballooning pattern, and long-term follow-up in a Swiss population. Int J Cardiol. 2009;135(3):370-5.
5.Strunk B, Shaw RE, Bull S, et al. High incidence of focal left ventricular wall motion abnormalities and normal coronary arteries in patients with myocardial infarctions presenting to a community hospital. J Invasive Cardiol. 2006;18(8):376-81.
6.Maruyama S, Nomura Y, Fukushige T, et al. Suspected takotsubo cardiomyopathy caused by withdrawal of bupirenorphine in a child. Circ J. 2006;70(4):509-11.
7.Kurisu S, Inoue I, Kawagoe T, et al. Presentation of Tako‐tsubo cardiomyopathy in men and women. Clin Cardiol. 2010;33(1):42-5.
8.Prasad A, Lerman A, Rihal CS. Apical ballooning syndrome (Tako-Tsubo or stress cardiomyopathy): a mimic of acute myocardial infarction. Am Heart J. 2008;155(3):408-17.
9.Wittstein IS, Thiemann DR, Lima JA, et al. Neurohumoral features of myocardial stunning due to sudden emotional stress. N Engl J Med. 2005;352(6): 539-48.
10.Eitel I, von Knobelsdorff-Brenkenhoff F, Bernhardt P, et al. Clinical characteristics and cardiovascular magnetic resonance findings in stress (takotsubo) cardiomyopathy. JAMA. 2011;306(3):277-86.
11.Maas AH, Rosano G, Cifkova R, et al. Cardiovascular health after menopause transition, pregnancy disorders, and other gynaecologic conditions: a consensus document from European cardiologists, gynaecologists, and endocrinologists. Eur Heart J. 2021;42(10):967-984.
12.Abraham J, Mudd JO, Kapur N, et al. Stress cardiomyopathy after intravenous administration of catecholamines and beta-receptor agonists. J Am Coll Cardiol. 2009;53(15):1320-5.
13.Martin EA, Prasad A, Rihal CS, et al. Endothelial function and vascular response to mental stress are impaired in patients with apical ballooning syndrome. J Am Coll Cardiol. 2010;56(22):1840-6.
14.Nef HM, Möllmann H, Kostin S, et al. Tako-Tsubo cardiomyopathy: intraindividual structural analysis in the acute phase and after functional recovery. Eur Heart J. 2007;28(20):2456-64.
15.Morel O, Sauer F, Imperiale A, et al. Importance of inflammation and neurohumoral activation in Takotsubo cardiomyopathy. J Card Fail. 2009;15(3):206-13.
16.Kuo BT, Choubey R, Novaro GM. Reduced estrogen in menopause may predispose women to takotsubo cardiomyopathy. Gend Med. 2010;7(1):71-7.
17.Choudhry NK, Brennan T, Toscano M, et al. Rationale and design of the Post-MI FREEE trial: A randomized evaluation of first-dollar drug coverage for post–myocardial infarction secondary preventive therapies. Am Heart J. 2008;156(1):31-6.
18.Zaroff JG, Pawlikowska L, Miss JC, et al. Adrenoceptor polymorphisms and the risk of cardiac injury and dysfunction after subarachnoid hemorrhage. Stroke. 2006;37(7):1680-5.
19.Pizzino G, Bitto A, Crea P, et al. Takotsubo syndrome and estrogen receptor genes: partners in crime? J Cardiovasc Med (Hagerstown). 2017; 18(4):268-276.
20.Vujovic KS, Stefanovic BS, Matic D, et al. Takotsubo Cardiomyopathy Precipitated By Thyroidectomy-A Case Report. Ser J Exp Clin Res. 22(2): 181-5.
21.Gupta S, Goyal P, Idrees S, et al. Association of endocrine conditions with takotsubo cardiomyopathy: a comprehensive review. J Am Heart Assoc. 2018;7(19):e009003.
22.Irigaray Echarri A, Ernaga Lorea A, Esparza Eguilaz N, et al. Takotsubo Syndrome and hyperthyroidism: a case report. An Sist Sanit Navar. 2019;42(2):215-220.
23.Rueda D, Aguirre R, Contardo D, et al. Takotsubo myocardiopathy and hyperthyroidism: a case report and literature Review. Am J Case Rep. 2017;18:865-870.
24.Murdoch D, O'callaghan W, Reda E, et al. Takotsubo cardiomyopathy associated with primary hyperthyroidism secondary to toxic multinodular goiter. Int J Angiol. 2016;25(5):e121-e122.
25.Patel K, Griffing GT, Hauptman PJ, et al. Recurrent takotsubo cardiomyopathy related to recurrent Thyrotoxicosis. Tex Heart Inst J. 2016;43(2):152-5.
26.Wu W-T, Hsu P-C, Huang H-L, et al. A case of Takotsubo cardiomyopathy precipitated by thyroid storm and diabetic ketoacidosis with poor prognosis. Acta Cardiol Sin. 2014;30(6):574-7.
27.Perkins MJ, Schachter DT. Biventricular Takotsubo cardiomyopathy in Graves hyperthyroidism. J Invasive Cardiol. 2014;26(3):E35-6.
28.Eliades M, El-Maouche D, Choudhary C, et al. Takotsubo cardiomyopathy associated with thyrotoxicosis: a case report and review of the literature. Thyroid. 2014;24(2):383-9.
29.Sarullo FM, Americo L, Accardo S, et al. Tako-tsubo cardiomyopathy observed in a patient with sepsis and transient hyperthyroidism. Monaldi Arch Chest Dis. 2009;72(1):33-6.
30.Kwon S-A, Yang JH, Kim M-K, et al. A case of Takotsubo cardiomyopathy in a patient with iatrogenic thyrotoxicosis. Int J Cardiol. 2010;145(3):e111-3.
31.Radhakrishnan A, Granato JE. An association between Takotsubo cardiomyopathy and thyroid storm. Postgrad Med. 2009;121(3):126-30.
32.Lee SJ, Kang JG, Ryu OH, et al. The relationship of thyroid hormone status with myocardial function in stress cardiomyopathy. Eur J Endocrino. 2009;160(5):799-806.
33.Balsa AM, Ferreira AR, Alves M, et al. Takotsubo cardiomyopathy associated with levothyroxine over-replacement. Eur Endocrinol. 2017;13(1):30-32.
34.Capel I, Tasa-Vinyals E, Cano-Palomares A, et al. Takotsubo cardiomyopathy in amiodarone-induced hyperthyroidism. Endocrinol Diabetes Metab Case Rep. 2017;2017:16-0116.
35.Aweimer A, El-Battrawy I, Akin I, et al. Abnormal thyroid function is common in takotsubo syndrome and depends on two distinct mechanisms: results of a multicentre observational study. J Intern Med. 2021;289(5):675-687.
36.Trivieri MG, Oudit GY, Sah R, et al. Cardiac-specific elevations in thyroid hormone enhance contractility and prevent pressure overload-induced cardiac dysfunction. Proc Natl Acad Sci U S A. 2006;103(15):6043-8.
37.Tang Y-D, Kuzman JA, Said S, et al. Low thyroid function leads to cardiac atrophy with chamber dilatation, impaired myocardial blood flow, loss of arterioles, and severe systolic dysfunction. Circulation. 2005;112(20):3122-30.
38.Pantos C, Dritsas A, Mourouzis I, et al. Thyroid hormone is a critical determinant of myocardial performance in patients with heart failure: potential therapeutic implications. Eur J Endocrinol. 2007;157(4):515-20.
39.Pingitore A, Iervasi G, Barison A, et al. Early activation of an altered thyroid hormone profile in asymptomatic or mildly symptomatic idiopathic left ventricular dysfunction. J Card Fail. 2006;12(7):520-6.
40.Pingitore A, Galli E, Barison A, et al. Acute effects of triiodothyronine (T3) replacement therapy in patients with chronic heart failure and low-T3 syndrome: a randomized, placebo-controlled study. J Clin Endocrinol Metab. 2008;93(4):1351-8.