Ann Pediatr Endocrinol Metab.  2023 Jun;28(2):144-148. 10.6065/apem.2142218.109.

Combination therapy of liothyronine and levothyroxine for hypothyroidism-induced dilated cardiomyopathy

• Choi Y
• Jung SY
• Park JM
• Suh J
• Shin EJ
• Chae HW
• Kim HS
• Kwon A

• KMID: 2543296
• DOI: http://doi.org/10.6065/apem.2142218.109

Abstract

Thyroid hormone plays a vital role in regulating human metabolism. They affect the functions of major organs, such as the brain, liver, skeletal muscle, and heart. Hypothyroidism can lead to dilated cardiomyopathy and decreased heart function. In this report, we describe a case of a teenage boy who developed dilated cardiomyopathy due to hypothyroidism and was considered to undergo heart transplantation. Levothyroxine monotherapy was initiated but produced no improvement. Thereafter, a combination therapy of liothyronine and levothyroxine was administered, and heart function was gradually restored; he recovered completely after 6 months. Cardiac myocytes respond more specifically to liothyronine than to levothyroxine. Therefore, we suggest that liothyronine and levothyroxine combination therapy should be considered rather than levothyroxine monotherapy for hypothyroidism accompanied by heart disease.

Keyword

Thyroid hormone; Hypothyroidism; Dilated cardiomyopathy; Heart failure; Triiodothyronine; Levothyroxine

Figure

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  Fig. 1. Chest x-ray on the first day after transfer. Chest x-ray showed cardiomegaly and right pleural effusion in initial chest x-ray (A) and showed normal findings at 12 months of follow-up (B).

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  Fig. 2. Markedly enlarged left ventricle with moderate mitral regurgitation was seen in the initial apical four-chamber view via transthoracic echocardiography (A), and decreased left ventricle to normal range without mitral regurgitation was seen in the same view at 12 months of follow-up (B).

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  Fig. 3. The 12-lead electrocardiography findings. The patient had sinus tachycardia in initial electrocardiography (A) and normal sinus rhythm at 12 months of follow-up (B).

Reference

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