Complete Atrioventricular Block Complicating Hypothyrodism

Ratchaneewan Kwancharoen; Swangjit Suraamornkul; Petch Rawdaree

doi:10.15605/jafes.026.01.11

Authors

Ratchaneewan Kwancharoen Endocrinology and Metabolism Unit, Bangkok Metropolitan Medical College and Vajira Hospital, Bangkok, Thailand
Swangjit Suraamornkul Endocrinology and Metabolism unit , Bangkok Metropolitant Medical Collage and Vajira Hospital,Bangkok,Thailand.
Petch Rawdaree Endocrinology and Metabolism Unit, Bangkok Metropolitan Medical College and Vajira Hospital, Bangkok, Thailand

DOI:

https://doi.org/10.15605/jafes.026.01.11

Keywords:

hypothyroidism, atrioventricular block<

Abstract

An 85-year old Thai woman was admitted to the hospital for dyspnea. Her ECG showed complete atrioventricular (AV) block. Her laboratory data upon admission revealed low serum thyroxine level and elevated thyrotropin level. Levothyroxine was started, and the AV conduction block was supported by a temporary pacemaker. At the end of the second week, her free T4 fell within normal range. The temporary pacemaker was subsequently removed. She was discharged without permanent pacing. This case demonstrated that hypothyroidism can cause complete atrioventricular block. Levothyroxine replacement can restore AV conduction in the hypothyroid patient.

Downloads

Download data is not yet available.

References

Brent G, Davies TF, Larsen PR. Hypothyroidism and thyroiditis. In: Kronenberg HM, Melmed S, Polonsky KS, Larsen PR, eds. Williams Textbook of Endocrinology. 11th ed. Philadephia: Saunders Elsevier; 2008:377-409.

Freedberg AS, Papp JG, Williams EMV. The effect of altered thyroid state on atrial intracellular potentials. J Physiol. 1970;207(2):357-69. PMCID: PMC1348711.

Kahaly GJ, Dillmann WH. Thyroid hormone action in the heart. Endocr Rev. 2005;26(5):704-28. PMID: 15632316. https://doi.org/10.1210/er.2003-0033.

Klein I, Ojamaa K. Thyroid hormone and the cardiovascular system. N Engl J Med. 2001 ;344(7):501-9. PMID: 11172193. https://doi.org/10.1056/NEJM200102153440707.

Kahaly GJ. Cardiovascular and athrogenic aspects of subclinical hypothyroidism. Thyroid. 2000;10(8):665-79. PMID: 11014311. https://doi.org/10.1089/10507250050137743.

Ceresini G, Lauretani F, Maggio M, Ceda GP, Morganti S, Usberti E, et al, Thyroid function abnormalities and cognitive impairment in the elderly: Results of the InCHIANTI study. J Am Geriatr Soc. 2009;57(1):89-93. PMCID: PMC2631617. https://doi.org/10.1111/j.1532-5415.2008.02080.x.

Cappola AR, Fried LP, Arnold AM, Danese MD, Kuller LH, Burke GL, et al., Thyroid status, cardiovascular risk, and mortality in older adults. JAMA. 2006;295(9):1033-41. PMID: 16507804. PMCID: PMC1387822. https://doi.org/10.1001/jama.295.9.1033.

Schoenmakers N, de Graaff WE, Peters RH. Hypothyroidism as the cause of atrioventricular block in an elderly patient. Neth Heart J. 2008;16(2):57-9. PMID: 18335023. PMCID: PMC2245813.

Fragakis N, Katsaris G. Arrhythmias in the elderly: Modern management. Hellenic J Cardiol. 2006;47(2):84-92.

Singh JB, et al., Reversible atrioventricular block in myxedema. Chest. 1973;63(4):582-5. PMID: 16752528.

Schantz ET, Dubbs AW. Complete auriculoventricular block in myxedema with reversion to normal sinus rhythm on thyroid therapy. Am Heart J. 1951;41(4):613-9. PMID: 14818966.

Nakayama Y, et al., A case of transient 2:1 atrioventricular block, resolved by thyroxine supplementation for subclinical hypothyroidism. Pacing Clin Electrophysiol. 2006;29(1):106-8. PMID: 16441726. https://doi.org/10.1111/j.1540-8159.2006.00284.x.