Insuficiencia cardiaca por hipotiroidismo primario. Revisión a propósito de un caso / Heart failure due to primary hypothyroidism. Case report and review
DOI:
https://doi.org/10.24875/RMIMSS.M20000019Palabras clave:
Hipotiroidismo, Cardiomiopatía Dilatada, Insuficiencia Cardíaca / Hypothyroidism, Cardiomyopathy, Dilated, Heart FailureResumen
Resumen
Introducción: Se reconoce la relación existente entre las hormonas tiroideas, el corazón y el sistema vascular periférico. Las hormonas tiroideas tienen relevantes acciones sobre el corazón y la circulación, y generan múltiples cambios, incluyendo alteraciones hemodinámicas y efectos mediados sobre las células cardiacas a través de la expresión génica.
Caso clínico: Presentamos el caso de una paciente de 63 años con diagnóstico al ingreso de miocardiopatía dilatada con fracción de eyección reducida, en quien se pensó en enfermedad coronaria como primera causa, debido a sus antecedentes, pero en su evolución se fueron presentando otras posibles etiologías.
Conclusiones: Se realizaron numerosos estudios diagnósticos complementarios, como cinecoronariografía, resonancia magnética cardiaca y análisis de laboratorio, entre otros, y se llegó a la conclusión de que la causa fue hipotiroidismo primario.
Abstract
Background: There are well-recognized relationships between thyroid hormones, heart and peripheral vascular system. Thyroid hormones have relevant actions on the heart and circulation, generate multiple effects including hemodynamic changes and exert mediated effects on cardiac cells through gene expression.
Clinical case: We present a 64-year-old woman with diagnosis of dilated cardiomyopathy with reduced ejection fraction, in whom coronary disease was thought of as the most probable etiology by clinical antecedents but in the evolution, other possible etiologies were to appear.
Conclusions: Numerous complementary diagnostic studies were carried out, such as cinecoronariography, cardiac nuclear magnetic resonance imaging, laboratory analysis, to name a few, and it was concluded that the etiological cause was due to primary hypothyroidism.
Descargas
Referencias
Elliott P, Andersson B, Arbustini E, Bilinska Z, Cecchi F, Charron P. Classification of the cardiomyopathies:a position statement from the European Society of Cardiology Working Group on Myocardial and Pericardial Diseases. Eur Heart J. 2008;29:270-6.
Klein I, Danzi S. Thyroid disease and the heart. Circulation. 2007;116:1725-35.
Grais IM, Sowers JR. Thyroid and the heart. Am J Med. 2014;127(8):691-8.
Galli E, Pingitore A, Iervasi G. The role of thyroid hormone in the pathophysiology of heart failure:clinical evidence. Heart Fail Rev. 2010;15:155-69.
Kota SK, Tripathy PR, Kota SK, Jammula S, Meher LK, Modi KD. Primary hypothyroidism:uncommon presentation with reversible dilated cardiomyopathy in a young subject. Int J Endocrinol Metab. 2012;10(1):440-3.
Zondek H. Das myxodemherz. Munch Med Wochenschr. 1918;65:1180-3.
Ladenson PW, Sherman SI, Baughman KL, Ray PE, Feldman AM. Reversible alterations in myocardial gene expression in a young man with dilated cardiomyopathy and hypothyroidism. Proc Natl Acad Sci USA.1992;89:5251-5.
García-Martínez M, Rodrigo-Jarque I, Zuazola-Martínez MP. La insuficiencia cardíaca como primera manifestación del hipotiroidismo primario familiar. Rev Esp Cardiol. 1997;50:670-2.
Brito D, Pedro M, Bordalo A, Orgando AL, Aguiar A, Gouveia R, et al. Dilated cardiomyopathy due to endocrine dysfunction. Rev Port Cardiol. 2003;22(3):377-87.
Bezdah L, Sliméne H, Kammoun M, Haddad A, Belhani A. Myocardiopathie dilated origine myxoedemateuse. Ann Cardiol Angeiol. 2004;53:217-20.
Stănescu C, Branidou K, Ranetti EA. Heart failure and dilated cardiomyopathy associated with severe longstanding untreated hypothyroidism. Rom J Intern Med. 2007;45:77-83.
Bhardwaj R. Hypothyroidism presenting as dilated cardiomyopathy. Med J Armed Forces India. 2009;65:284-6.
Khochtali I, Hamza N, Harzallah O, Hamdi S, Saad J, Golli M, et al. Reversible dilated cardiomyopathy caused by hypothyroidism. Int Arch Med. 2011;4:20.
Saad AK, López-Soutric G, Nowicky Y, Lerman J, Vázquez-Blanco M. Hipotiroidismo, miocardiopatía dilatada y síndrome nefrótico durante el embarazo. Medicina. 2011;71:45-8.
Seol MD, Lee YS, Kim DK, Choi YH, Kim DJ, Park SH, et al. Dilated cardiomyopathy secondary to hypothyroidism:case report with a review of literatures. J Cardiovasc Ultrasound. 2014;22(1):32-5.
Madan N, Tiwari, Stampfer M, Schubart U. Hypothyroid heart:myxoedema as a cause of reversible dilated cardiomyopathy. BMJ Case Report. 2015;2015:bcr2015212045.
Gencer B, Collet TH, Virgini V, Bauer DC, Gussekloo J, Cappola AR, et al. Subclinical thyroid dysfunction and the risk of heart failure events:an individual participant data analysis from 6 prospective cohorts. Circulation. 2012;126:1040-9.
Curotto-Grasiosi J, Peressotti B, Machado RA, Filipini EC, Angel A, Delgado J, et al. Improvement in functional capacity after levothyroxine treatment in patients with chronic heart failure and subclinical hypothyroidism. Endocrinol Nutr. 2013;60(8):427-32.
Silva-Tinoco R, Castillo-Martínez L, Orea-Tejeda A, Orozco-Gutiérrez J, Vázquez-Díaz O, Montaño-Hernández P, et al. Developing thyroid disorders is associated with poor prognosis factors in patient with stable chronic heart failure. Int J Cardiol. 2011;147:e24-5.
Rodondi N, Newman AB, Vittinghoff E, Rekeneire N, Satterfield S, Harris T, et al. Subclinical hypothyroidism and the risk of heart failure, other cardiovascular events, and death. Arch Intern Med. 2005;165:2460-6.
Publicado
Versiones
- 13-06-2025 (2)
- 13-04-2020 (1)
Número
Sección
Licencia
Los autores conservan sus derechos de autor y otorgan a la Revista Médica del IMSS el derecho de primera publicación. Los artículos se distribuyen bajo una Licencia Creative Commons Atribución-NoComercial-SinDerivar 4.0 Internacional, que permite su difusión siempre que se reconozca al autor y la fuente original.
