CASE REPORT article
Front. Cardiovasc. Med.
Sec. General Cardiovascular Medicine
This article is part of the Research TopicCase Reports in General Cardiovascular Medicine: 2024View all 17 articles
Takotsubo syndrome with apical thrombosis associated with hyperthyroidism crisis: A case report from high-altitude Tibet
Provisionally accepted
- 1University of Electronic Science and Technology of China, Chengdu, Sichuan Province, China
- 2Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, China
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Background Catecholamine surge is considered the primary trigger of Takotsubo syndrome(TTS), but its pathophysiological mechanisms remain incompletely understood. Cases of TTS with intracardiac thrombus induced by thyrotoxicosis in the setting of high-altitude hypoxia are particularly rare. Case Summary A 65-year-old woman living at 3,200 m was admitted with abdominal and chest pain. On admission, her BP was 108/68 mmHg, HR 135 bpm, Temp 37.8 °C, and SpO₂ 95% on room air. Hemoglobin was 168 g/L, consistent with chronic high-altitude adaptation.Coronary angiography at the local hospital showed mild stenosis of the left anterior descending artery. She presented with tachycardia, marked ST-segment elevation, and elevated troponin T and B-type natriuretic peptide (BNP) levels.The ST-segment elevation gradually resolved during hospitalization, arguing against acute myocardial infarction. However, markedly elevated thyroid hormone and thyrotropin receptor antibody levels were indicative of a thyroid storm. Transthoracic echocardiography (TTE) revealed apical hypokinesia and ballooning accompanied by an apical thrombus. Myocardial contrast echocardiography (MCE) indicated delayed and sparse perfusion in the apical segment, while Magnetic resonance imaging (MRI) ruled out remote myocardial injury. Mildly elevated myocardial enzymes and rapid resolution of ST-segment elevation supported the diagnosis of Takotsubo cardiomyopathy. Thyrotoxicosis may have enhanced myocardial sensitivity to catecholamines, predisposing to stress-related injury.Chronic high-altitude hypoxia can further increase sympathetic activity and impair coronary microcirculation. The patient was treated with β-blockers, antithyroid agents, and anticoagulation, along with supportive therapy targeting oxidative stress, which was followed by regression of the apical thrombus and improvement in cardiac function. Conclusion The combined effects of severe thyrotoxicosis and chronic high-altitude hypoxia may induce TTS and its related complications by enhancing sympathetic activity and catecholamine responsiveness.
Keywords: Thrombosis, Hyperthyroidism, Takotsubo syndrome, Echocardiography, high altitude
Received: 28 Feb 2025; Accepted: 13 Nov 2025.
Copyright: © 2025 zhang, yin and zhang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: qingfeng zhang, qingfengzhang518@126.com
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