Extracorporeal Membrane Oxygenation in Hyperthyroidism-Related Cardiomyopathy: Two Case Reports

Abstract

Hyperthyroidism-related cardiomyopathy complicated by acute heart failure and shock is a life-threatening condition. Due to the co-occurrence of systemic congestion, left ventricular systolic dysfunction, and reduced systemic vascular resistance, clinical management remains a major challenge in the intensive care unit. Extracorporeal membrane oxygenation (ECMO) provides temporary support in patients with refractory heart failure and cardiogenic shock. We describe two patients with severe hyperthyroidism-related cardiomyopathy. The first patient, a 33-year-old Chinese male, was newly diagnosed to have hyperthyroidism, presenting with thyroid storm and multi-organ failure. The second patient, a 35-year-old Chinese female, had relapsed Graves ’ disease complicated with hyperthyroidism-related cardiomyopathy and atrial fibrillation. Both patients developed acute heart failure and circulatory collapse, necessitating invasive hemodynamic support. They were hemodynamically supported with veno-arterial mode extracorporeal membrane oxygenation (VA-ECMO) and mechanical ventilation, which were successfully weaned off after 4 days. Subsequent echocardiography and cardiac magnetic resonance revealed normalization of the left ventricular ejection function. Hyperthyroidism-related cardiomyopathy with circulatory collapse is often a fatal condition. Given its highly reversible nature, more aggressive initial mechanical circulatory support in the form of VA-ECMO is warranted. doi: http://dx.doi.org/10.4021/jem144w