{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,4]],"date-time":"2026-07-04T08:33:48Z","timestamp":1783154028150,"version":"3.54.6"},"reference-count":12,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2020,11,12]],"date-time":"2020-11-12T00:00:00Z","timestamp":1605139200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,12,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background\u2003<\/jats:title>\n                  <jats:p>Thyroid storm is a rare condition with well-known cardiovascular manifestations including tachycardia, atrial fibrillation, heart failure, and myocardial infarction (MI). Several uncommon conditions that can mimic MI are associated with thyrotoxicosis and discussed in this case.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Case summary\u2003<\/jats:title>\n                  <jats:p>A 23-year-old previously healthy male presented after the onset of generalized weakness and inability to rise from bed in the setting of 35\u2009kg of unintentional weight loss, and was found to have profound hypokalaemia, elevated thyroid hormone, and suppressed thyroid-stimulating hormone consistent with thyrotoxicosis secondary to Grave\u2019s disease. Following hospital admission, he developed worsening tachycardia with dynamic anteroseptal ST-segment elevations and elevated cardiac biomarkers concerning for MI. He was treated with aspirin, ticagrelor, and a heparin infusion, but was unable to tolerate beta-blockade acutely due to hypotension. Echocardiography demonstrated a severely dilated left ventricle (left ventricular end-diastolic volume index 114\u2009mL\/m2) and severely reduced systolic function (ejection fraction 23%) with global hypokinesis. Following initiation of propylthiouracil, iodine solution, and stress-dosed steroids his tachycardia and ST-elevations resolved. Computed tomography (CT) coronary angiography demonstrated no evidence of coronary stenosis. He was discharged on methimazole, metoprolol, and lisinopril and found to have recovered left ventricular systolic function at 2-month follow-up.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Discussion\u2003<\/jats:title>\n                  <jats:p>Thyrotoxicosis can rarely cause coronary vasospasm, stress cardiomyopathy, and autoimmune myocarditis. These conditions should be suspected in hyperthyroid patients with features of MI and normal coronary arteries. Workup should include laboratory evaluation, electrocardiography (ECG), echocardiography, and non-invasive or invasive ischaemic evaluation.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ehjcr\/ytaa414","type":"journal-article","created":{"date-parts":[[2020,11,12]],"date-time":"2020-11-12T03:52:36Z","timestamp":1605153156000},"page":"1-5","source":"Crossref","is-referenced-by-count":5,"title":["Storm and STEMI: a case report of unexpected cardiac complications of thyrotoxicosis"],"prefix":"10.1093","volume":"4","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7620-7396","authenticated-orcid":false,"given":"Josiah","family":"Brown","sequence":"first","affiliation":[{"name":"Division of Cardiology, Department of Medicine, University of Washington, 1959 NE Pacific St, Seattle, WA 98195, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew D","family":"Cham","sequence":"additional","affiliation":[{"name":"Department of Radiology, University of Washington, 1959 NE Pacific St, Seattle, WA 98195, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4313-9988","authenticated-orcid":false,"given":"Gary S","family":"Huang","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medicine, University of Washington, 1959 NE Pacific St, Seattle, WA 98195, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2020,11,12]]},"reference":[{"key":"2021010812214710100_ytaa414-B1","doi-asserted-by":"crossref","first-page":"501","DOI":"10.1056\/NEJM200102153440707","article-title":"Thyroid hormone and the cardiovascular system","volume":"344","author":"Klein","year":"2001","journal-title":"N Engl J Med"},{"key":"2021010812214710100_ytaa414-B2","doi-asserted-by":"crossref","first-page":"1993","DOI":"10.1001\/archinte.160.13.1993","article-title":"Excess triiodothyronine as a risk factor of coronary events","volume":"160","author":"Peters","year":"2000","journal-title":"Arch Intern Med"},{"key":"2021010812214710100_ytaa414-B3","doi-asserted-by":"crossref","first-page":"983.e5","DOI":"10.1016\/j.ajem.2014.12.071","article-title":"Painless thyroiditis-induced acute myocardial infarction with normal coronary arteries","volume":"33","author":"Zheng","year":"2015","journal-title":"Am J Emerg Med"},{"key":"2021010812214710100_ytaa414-B4","first-page":"e1323","article-title":"Thyrotoxicosis mimicking ST elevation myocardial infarction","volume":"9","author":"De Marchena Ingrid","year":"2017","journal-title":"Cureus"},{"key":"2021010812214710100_ytaa414-B5","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/1756-6614-3-1","article-title":"Acute myocardial infarction as the first presentation of thyrotoxicosis in a 31-year old woman\u2014case report","volume":"3","author":"Lewandowski Krzysztof","year":"2010","journal-title":"Thyroid Res"},{"key":"2021010812214710100_ytaa414-B6","doi-asserted-by":"crossref","first-page":"593","DOI":"10.2169\/internalmedicine.49.2504","article-title":"Thyroid storm and lymphocytic myocarditis","volume":"49","author":"Chen","year":"2010","journal-title":"Intern Med"},{"key":"2021010812214710100_ytaa414-B7","doi-asserted-by":"crossref","first-page":"166","DOI":"10.1016\/j.ijcard.2012.04.089","article-title":"Hyperthyroidism induced autoimmune myocarditis. 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