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Dr Aditya Bhat, Dr, Amit Misri

Department of Paediatric Cardiology, Medanta-The Medicity, Gurgaon

Background Results Interventions

• A 5 month old previously well infant • Lack of inflammatory markers • Started on oral Thyroxin [12.5-
who presented with recent onset sterile blood cultures and negative 25mcg/day] along with continued
severe respiratory distress. viral assays for myocarditis. decongestive measures which led to
• Possibility of non-inflammatory marked improvement in cardiac
• Physical examination was otherwise DCMP function.
unremarkable [weight-7.2kg, length • Serum electrolytes and Vitamin D • TSH normalized
62cm] with no developmental delay.. levels normal. • At 6 month follow up he was
• Xray chest showed cardiomegaly • Cardiac troponins slightly elevated growing well [weight 8.5 kg, length
[cardiothoracic ratio 0.7] and [Trop I-0.42 ng/ml]. 73cm],had normal neurodevelopment
normal lung shadows. • Carnitine deficiency and organic with near normal cardiac function
acidurias were ruled out by TMS and decrease in LV dilatation
• ECG revealed sinus tachycardia and [LVIDd ↓from 38 to 30 mm and
features of Left ventricular [LV] • Endocrine evaluation showed grossly LVIDs from 34 to 25 mm, ]
enlargement. elevated TSH levels [461 µIU/ml] Conclusions
with low free T3 [3.3pg/ml] and
• ECHO showed grossly dilated LV free T4 level [0.63ng/dl]. • Based on clinical findings and a
with severe dysfunction [LVEF 20 • On ultrasound, there was absence stepwise approach, diagnosis of
%], global LV hypokinesia and of thyroid gland in neck. congenital hypothyroidism associated
moderate mitral regurgitation. LV dilated cardiomyopathy was
outflow tract, aortic arch and established and successfully
coronaries were normal. treated.
• Despite thyroid hormones having a
• A presumptive diagnosis of dilated
direct effect on calcium mediated
cardiomyopathy [DCMP]/ acute
cardiac contractility; hypothyroidism
fulminant myocarditis was
has been rarely seen as a primary
considered and patient started on
cause of severe LV dysfunction in
decongestive measures, oral digoxin
and inotropic support.
• This case highlights the role of
finding a treatable cause in all
paediatric DCMP cases before
labelling them as “idiopathic”
•TC99m Pertechnetate scan showed non
visualization of thyroid gland and a small
ectopic lingual thyroid. Designed & Printed at KL Wig CMET, AIIMS