Broken heart syndrome triggered by an obstructive goiter not associated with thyrotoxicosis

• DOI: 10.1007/s12630-013-9964-0
• Publication Date: 2013-07-10T19:31:44Z
• Authors: Roupen Hatzakorzian; Helen Bui; Thomas Schricker; Steven B. Backman
• Keywords: Heart Failure; Intra-Aortic Balloon Pumping; Myeloproliferative Disorders; Phenylalanine; Valine; Janus Kinase 2; 3. Good health; Airway Obstruction; 03 medical and health sciences; 0302 clinical medicine; Echocardiography; Takotsubo Cardiomyopathy; Goiter, Substernal; Mutation; Humans; Female; Respiratory Insufficiency; Tracheal Stenosis; Aged; Goiter, Nodular

Takotsubo cardiomyopathy (TC) is described as transient ventricular dysfunction following emotional or physical trauma. A few reports have described patients with TC in association with various circumstances of thyrotoxicosis. We report an unusual case of TC in a patient with a large retrosternal goiter and normal thyroid function. We speculate that TC was triggered by compromise of tracheal flow induced by the goiter.A 68-yr-old woman without primary heart disease presented with cardiorespiratory collapse requiring ventilatory and cardiovascular support, including placement of an intra-aortic balloon pump. She was diagnosed with a severe form of TC based on characteristic echocardiography findings and clinical course. Within less than a week, her myocardial function completely normalized. The patient was later found to have a large retrosternal goiter compressing her trachea, though her thyroid function was normal. A total thyroidectomy was eventually performed, and she made a full recovery. Subsequently, the patient was found to have a positive JAK2 mutation for a myeloproliferative disorder.Takotsubo cardiomyopathy may be regarded as the final common pathway of cardiac dysfunction triggered by various stress conditions, in this case, a large retrosternal goiter not associated with thyrotoxicosis and likely exacerbated by severe leukocytosis related to a myeloproliferative disorder.