J Korean Endocr Soc.  2008 Oct;23(5):332-336. 10.3803/jkes.2008.23.5.332.

A Patient with Primary Amyloidosis Misrecognized as Thyrotoxicosis-induced Heart Failure

• Lee SJ
• Lee SH
• Chin JY
• Song YM
• Lee SW
• Kim MH
• Kang MJ
• Lee KW
• Kwon HS
• Yoon KH
• Son HY
• Cha BY

• KMID: 1479226
• DOI: http://doi.org/10.3803/jkes.2008.23.5.332

Abstract

Amyloidosis is caused by deposition of insoluble amyloid protein in the extracellular space of organs and tissues. The causes of amyloidosis are classified as primary, secondary, and hereditary, and symptoms develop according to which organ is involved. Cardiac amyloidosis induces cardiomyopathy and is developed by deposition of amyloid proteins in cardiac tissue. We diagnosed a patient with rhabdomyolysis and thyrotoxicosis with underlying Graves' disease 5 years ago. The patient was readmitted recently complaining of general weakness and mild dyspnea, and was diagnosed as relapsed thyrotoxicosis. An echocardiogram was performed for the evaluation of dyspnea and the findings were compatible with infiltrative cardiomyopathy due to amyloidosis. A biopsy of the abdominal subcutaneous fat and rectal mucosa was performed, and diagnosis was amyloidosis with histologic findings. The cause of heart failure was therefore cardiac amyloidosis rather than thyrotoxicosis. This case indicates the importance of evaluating the cause of heart failure in patients with thyrotoxicosis.

Keyword

cardiac amyloidosis; Graves' disease; heart failure; thyrotoxicosis

MeSH Terms

Amyloid
Amyloidogenic Proteins
Amyloidosis
Biopsy
Cardiomyopathies
Dyspnea
Extracellular Space
Graves Disease
Heart
Heart Failure
Humans
Mucous Membrane
Rhabdomyolysis
Subcutaneous Fat, Abdominal
Thyrotoxicosis
Amyloid
Amyloidogenic Proteins
Amyloidosis