Case Report
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Aug 6, 2023; 11(22): 5316-5321
Published online Aug 6, 2023. doi: 10.12998/wjcc.v11.i22.5316
Rapid progression of heart failure secondary to radioactive iodine treatment of hyperthyroidism: A case report
Zi-Han Li, Lu-Jia Ni, Yuan-Qiao Liu, Dao-Yuan Si
Zi-Han Li, Yuan-Qiao Liu, Dao-Yuan Si, Department of Cardiology, China-Japan Union Hospital of Jilin University, Changchun 130033, Jilin Province, China
Zi-Han Li, Yuan-Qiao Liu, Dao-Yuan Si, Jilin Provincial Engineering Laboratory for Endothelial Function, China-Japan Union Hospital of Jilin University, Changchun 130033, Jilin Province, China
Lu-Jia Ni, Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun 130033, Jilin Province, China
Author contributions: Li ZH drafted the manuscript; Ni LJ contributed to data and image collection; Liu YQ cared for the patient and provided data; Si DY provided consultation and coordination of the manuscript; All authors reviewed and approved the final manuscript.
Supported by Science and Technology of Jilin Province, No. 20200801076GH.
Informed consent statement: The patient provided informed written consent for the publication of this case report.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Dao-yuan Si, MD, PhD, Associate Chief Physician, Associate Professor, Department of Cardiology, China-Japan Union Hospital of Jilin University, No. 126 Xiantai Street, Changchun 130033, Jilin Province, China. sidaoyuan@jlu.edu.cn
Received: April 4, 2023
Peer-review started: April 4, 2023
First decision: June 12, 2023
Revised: June 23, 2023
Accepted: July 17, 2023
Article in press: July 17, 2023
Published online: August 6, 2023
Abstract
BACKGROUND

The deterioration of thyroid health is involved in the progression of heart failure (HF). This is usually a lengthy process, so there are almost no reports on its rapid development. Here we report a case of a young male who rapidly developed hypothyroid cardiomyopathy secondary to radioactive iodine treatment, suggesting that severe HF might occur even after a short period of hypothyroidism.

CASE SUMMARY

A 26-year-old man was referred to our hospital for HF presenting with dyspnea on exertion and chest discomfort lasting for 1 mo. He received radioactive iodine treatment for hyperthyroidism 1 year ago and had an almost normal echocardiogram 6 mo ago. Admission echocardiogram and cardiac magnetic resonance (CMR) revealed left ventricle (LV) global hypokinesia and severely depressed systolic function. In addition, late gadolinium enhancement indicated no obvious changes in the myocardium. Thyroid function tests showed decreased serum levels of thyroid hormone (TH) and elevated thyroid-stimulating hormone. Based on an exclusionary examination, the patient was diagnosed with hypothyroid cardiomyopathy and was started on replacement therapy. His HF symptoms were completely relieved during the six-month follow-up, and echocardiogram and CMR revealed recovered LV size and ejection fraction.

CONCLUSION

This report demonstrates that severe fluctuations in TH levels may lead to acute HF, which can completely recover with timely thyroid hormone replacement. In addition, our findings highlight the importance of routinely detecting cardiac function in patients treated with radioactive iodine.

Keywords: Heart failure, Hypothyroid cardiomyopathy, Hormone replacement therapy, Radioactive iodine therapy, Case report

Core Tip: We present the case of a young man who had clinical manifestations of heart failure but an almost normal echocardiogram some 6 mo ago. His condition progressed rapidly, and auxiliary examinations ruled out other diseases. The diagnosis of hypothyroid cardiomyopathy was retrospective and exclusive. We must pay attention to changes in cardiac function after radioactive iodine treatment and consider the possibility of hypothyroid cardiomyopathy when the symptoms of heart failure appear.