Unusual presentation of thyrotoxicosis as complete heart block and renal failure: a case report

<p>Abstract</p> <p>Introduction</p> <p>Thyrotoxicosis is a clinical entity often very difficult to diagnose without biochemical confirmation as its clinical features can be highly varied. The most common cardiac manifestations of thyrotoxicosis are resting sinus tachycardia, supraventricular tachycardia including atrial fibrillation and atrial flutter with or without cardiac failure. Bradycardia and atrio-ventricular conduction defects are very uncommon in thyrotoxicosis.</p> <p>Case presentation</p> <p>We report the case of a 59-year-old Caucasian man presenting with progressive weight loss, abnormal liver function, acute renal failure and complete heart block due to thyrotoxicosis.</p> <p>Conclusion</p> <p>Thyrotoxicosis should be considered as a possible diagnosis in patients with bradycardia and heart blocks associated with abnormal symptoms like weight loss. Nevertheless, the clinical, electrophysiological and biochemical abnormalities associated with thyrotoxicosis may be completely reversible restoring euthyroid state.</p

Supplementary Material for: Imaging in Endocrine Disorders

Ultrasonography (US) represents the most sensitive and efficient method for the evaluation of the thyroid and parathyroid glands. Infectious and autoimmune thyroiditis are common diseases, usually diagnosed and followed up by clinical examination and laboratory analyses. Nevertheless, US plays an important role in confirming diagnoses, predicting outcomes and, in autoimmune hyperthyroidism, in titrating therapy. Conversely, in nodular thyroid disease US is the imaging method of choice for the characterization and surveillance of lesions. It provides consistent clues in predicting the risk of malignancy, thus directing patient referral for fine-needle aspiration (FNA) biopsy. Suspicious US features generally include marked hypoechogenicity, a shape taller than it is wide, ill-defined or irregular borders, microcalcifications and hardness at elastographic evaluation. Finally, the role of US in thyroid cancer is to evaluate extension beyond the thyroid capsule and to assess nodal metastases or tumor recurrence. The main application of US in parathyroid diseases is represented by primary hyperparathyroidism. In this condition, US plays a role after biochemical diagnosis, and it should always be strictly performed for localization purposes. In both thyroidal and parathyroid diseases, US is recommended as a guide in FNA biopsies