Myxedema coma and cardiac ischemia in relation to thyroid hormone replacement therapy in a 38-year-old Japanese woman

Clinical Therapeutics
Takafumi TaguchiKozo Hashimoto

Abstract

Although thyroid hormone deficiency, either clinical or subclinical, is an established risk factor for cardiovascular disease, coronary ischemia in a premenopausal woman in her 30s is relatively rare. A 38-year-old woman was referred to our hospital with severe breathlessness and depressed consciousness. Physical examination found facial, abdominal, and pretibial edema; coarse hair, hoarse voice, and dry skin; engorged jugular veins; a distant heart sound; and reduced bilateral entry of air into the chest. Laboratory examinations revealed severe hypothyroidism, hyperlipidemia, and elevated serum levels of carcinoembryonic antigen (CEA) and carbohydrate antigen 125 (CA125). A computed tomography scan showed massive pleural and pericardial effusions. After 3 months of levothyroxine replacement therapy (initial dose: 12.5 microg/d; maintenance dose: 125 microg/d), all abnormal laboratory values associated with hypothyroidism returned to within normal ranges, with the exception of a transient and paradoxical rise in serum thyroid-stimulating hormone levels. However, 3 weeks after the initiation of therapy, the patient reported intermittent chest pains during the course of therapy, and a coronary artery angiogram revealed diffuse st...Continue Reading

Citations

Feb 19, 2011·Journal of Cardiothoracic and Vascular Anesthesia·Robert J Deegan, William R Furman
Sep 9, 2010·Heart, Lung & Circulation·Kenneth A Sikaris
May 1, 2009·International Journal of Cardiology·Annalisa LamariSalvatore Patanè
Apr 21, 2009·International Journal of Cardiology·Giuseppe DattiloSalvatore Patanè
May 6, 2008·Pharmacology & Therapeutics·Constantinos PantosDennis Cokkinos
Jul 22, 2008·Pharmacoepidemiology and Drug Safety

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