Hernández Pavel Antonio Montes, Salcedo Dylani Rosa Ávila, Pedro Jorge Alejandro Ayala San
Department of Internal Medicine, Xoco General Hospital, Mexico City, Mexico.
Department of Internal Medicine, Ticomán General Hospital, Mexico City, Mexico.
Eur J Case Rep Intern Med. 2025 Jun 27;12(7):005526. doi: 10.12890/2025_005526. eCollection 2025.
Myopericarditis is an uncommon but potentially severe complication of thyroid dysfunction. Although cardiovascular manifestations of hyperthyroidism are well documented, its association with myocardial and pericardial inflammation is rare and diagnostically challenging.
A 36-year-old previously healthy male presented with precordial chest pain and a 1-month history of diarrhoea, heat intolerance, palpitations, and unintentional weight loss. Laboratory evaluation revealed elevated cardiac biomarkers, and electrocardiogram showed diffuse ST-segment elevation suggestive of acute pericarditis. Coronary angiography demonstrated no obstructive coronary lesions. Thyroid function tests revealed suppressed TSH and markedly elevated free T4, with positive anti-thyroglobulin antibodies. Thyroid scintigraphy confirmed decreased uptake consistent with thyroiditis. A diagnosis of myopericarditis secondary to silent autoimmune thyroiditis was established. The patient was treated with nonsteroidal anti-inflammatory drugs, colchicine, beta-blockers, and methimazole, achieving complete clinical and biochemical recovery.
This case emphasizes the importance of considering thyroid dysfunction in patients presenting with myopericarditis. Early recognition and targeted management can reverse myocardial injury and optimize patient outcomes.
Myopericarditis may be the initial and sole manifestation of silent autoimmune thyroiditis. Thyroid function testing should be routinely considered in young patients with chest pain and elevated troponins but normal coronary arteries.Early identification of thyroid dysfunction allows complete reversal of cardiac involvement with appropriate endocrine and anti-inflammatory treatment, preventing unnecessary invasive procedures.This case highlights a practical diagnostic pitfall that internists may encounter and underscores the importance of integrating endocrine evaluation in unexplained cardiac presentations.
心肌心包炎是甲状腺功能障碍一种罕见但可能严重的并发症。尽管甲状腺功能亢进的心血管表现已有充分记录，但其与心肌和心包炎症的关联罕见且诊断具有挑战性。
一名36岁既往健康男性，出现心前区胸痛，并有1个月腹泻、不耐热、心悸及非故意体重减轻的病史。实验室检查显示心脏生物标志物升高，心电图显示弥漫性ST段抬高，提示急性心包炎。冠状动脉造影显示无阻塞性冠状动脉病变。甲状腺功能检查显示促甲状腺激素（TSH）降低，游离甲状腺素（T4）显著升高，抗甲状腺球蛋白抗体阳性。甲状腺闪烁显像证实摄取减少，符合甲状腺炎表现。确诊为隐匿性自身免疫性甲状腺炎继发的心肌心包炎。患者接受了非甾体抗炎药、秋水仙碱、β受体阻滞剂及甲巯咪唑治疗，实现了临床和生化指标的完全恢复。
本病例强调了在心肌心包炎患者中考虑甲状腺功能障碍的重要性。早期识别和针对性治疗可逆转心肌损伤并优化患者预后。
心肌心包炎可能是隐匿性自身免疫性甲状腺炎的初始且唯一表现。对于胸痛、肌钙蛋白升高但冠状动脉正常的年轻患者，应常规考虑进行甲状腺功能检查。早期识别甲状腺功能障碍，通过适当的内分泌和抗炎治疗可使心脏受累完全逆转，避免不必要的侵入性检查。本病例突出了内科医生可能遇到的一个实际诊断陷阱，并强调了在不明原因心脏表现中纳入内分泌评估的重要性。
