# Severely Dilated Cardiomyopathy and Cardiogenic Shock in a Patient With Thyroid Storm

## TL;DR

A patient with thyroid storm developed severe heart failure, but her condition improved with timely treatment, showing the importance of early diagnosis and individualized care.

## Contribution

This case report highlights the rare occurrence of dilated cardiomyopathy caused by thyroid storm and emphasizes the effectiveness of targeted treatment.

## Key findings

- Thyroid storm can lead to severe dilated cardiomyopathy and cardiogenic shock.
- Timely treatment with methimazole, hydrocortisone, and cholestyramine improved cardiac function and overall condition.
- Individualized treatment is crucial in complex cases involving coexisting conditions like liver dysfunction.

## Abstract

Thyroid storm describes a rare, life-threatening hypermetabolic state characterized by an excessive activation of the sympathetic nervous system and heightened sensitivity to circulating catecholamines. We present a case of thyroid storm with severe dilated cardiomyopathy (DCM) and cardiogenic shock.

A 39-year-old woman with a history of hyperthyroidism was admitted following ventricular fibrillation arrest and cardiogenic shock requiring extracorporeal membrane oxygenation (ECMO) support. Clinical findings included proptosis, diffuse thyromegaly, acute kidney injury, shock liver, severe metabolic acidosis, and a severely dilated heart with an ejection fraction of 17%. Thyroid function tests confirmed Graves disease. The patient was treated with methimazole, hydrocortisone, and cholestyramine. Her condition improved, enabling successful weaning from ECMO and vasopressors with recovery of cardiac function. The patient was discharged to rehabilitation on heart failure therapy and methimazole, with follow-up arranged.

This case highlights the rare occurrence of DCM secondary to thyroid storm, underscoring the importance of early recognition and treatment. Thyrotoxicosis can lead to significant cardiac dysfunction, but timely intervention can reverse myocardial damage and improve outcomes. This report emphasizes the need for individualized treatment approaches, especially in cases complicated by coexisting conditions such as hepatic dysfunction.