Heart failure after aortic valve substitution due to severe hypothyroidism

We report a case of a 70-year-old female with considerable co-morbidities (Type 2 diabetes, Leiden factor V mutation, mild to moderate chronic obstructive pulmonary disease) and a recent biological aortic valve substitution, who was admitted due to circulatory collapse caused by severe heart failure with an ejection fraction of 10%. The patient was treated with diuretics and inotropic drugs with only a minor effect on the condition. A thyroid status disclosed a condition of overt hypothyreosis (TSH: 70 miu/L, T4: 19 nmol/L, T3 0.8: nmol/L). Cautious treatment with peroral Levothyroxin and hydrocortisone was given as a supplement to the heart failure treatment and the condition improved gradually. Within 3 months the patient was euthyroid and had regained her habitual LV function.