Thyrotoxicosis-Induced Myopericarditis as the Initial Presentation of Graves’ Disease

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Thyrotoxicosis-induced myopericarditis (n=1). Intervention: Anti-inflammatory and antithyroid therapy. Primary outcome: Symptom resolution and thyroid function improvement.

Q: What does this research mean for the field?

Combined treatment with anti-inflammatory therapy, antithyroid medications, beta-blockers, and corticosteroids leads to complete resolution of thyrotoxicosis-induced myopericarditis presenting as an acute coronary syndrome mimic. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.NEUTRAL.

Pragya Bhandari; Suhail Sapkota; S K Pande; Nirajan Kandel; Nirmal Guragai

doi:10.7759/cureus.110734

June 12, 2026CureusOpen Access

Thyrotoxicosis-Induced Myopericarditis as the Initial Presentation of Graves’ Disease

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Why the study?

Thyrotoxicosis-induced myopericarditis is an uncommon cardiovascular manifestation of Graves' disease that may closely mimic acute coronary syndrome.

Key Points

To describe an uncommon initial manifestation of Graves' disease presenting as thyrotoxicosis-induced myopericarditis that closely mimicked acute coronary syndrome.
Diagnostic evaluation of a 42-year-old woman presenting with severe chest pain, ST-segment elevations, dynamic high-sensitivity troponin elevation, and non-obstructive coronary arteries on urgent angiography.
Assessment of systemic thyroid toxicity using the Burch-Wartofsky Point Scale alongside inflammatory markers, thyroid panels, and thyrotropin receptor antibody testing.
Treatment with propylthiouracil (150 mg three times daily), propranolol (40 mg four times daily), hydrocortisone (100 mg intravenously every eight hours for three doses), ibuprofen (600 mg three times daily), and colchicine (0.6 mg twice daily).
Initial laboratory evaluation demonstrated suppressed TSH (<0.01 uIU/mL), elevated free T4 (4.68 ng/dL), elevated free T3 (23.7 pg/mL), peak high-sensitivity troponin of 261 ng/L, and a Burch-Wartofsky score of 40 indicating impending thyroid storm.
Serologic testing confirmed Graves' disease with an elevated thyrotropin receptor antibody level of 15.3 IU/L compared with the normal reference of <1.75 IU/L.
At one-month follow-up, chest pain completely resolved and free T4 decreased from 4.68 ng/dL to 1.66 ng/dL while TSH remained suppressed at <0.01 uIU/mL.

Study Design

Type

Case Report (n=1)

Multicenter

No

Structured PICO

P

Population

A 42-year-old woman with obesity and tobacco use presenting with severe chest pain, ST-segment elevations, and impending thyroid storm.

I

Intervention

Anti-inflammatory therapy (ibuprofen 600 mg TID, colchicine 0.6 mg BID), antithyroid medications (propylthiouracil 150 mg TID transitioned to methimazole 30 mg daily), beta-blockers (propranolol 40 mg QID), and corticosteroids (hydrocortisone 100 mg IV q8h for 3 doses).

O

Outcome

Clinical improvement and resolution of symptoms and thyrotoxicosis

Thyrotoxicosis-induced myopericarditis is a rare but important cardiovascular manifestation of Graves' disease that can mimic acute coronary syndrome and requires prompt recognition and targeted therapy.

Limitations

Cardiac magnetic resonance imaging (CMR) was not performed to definitively confirm tissue characterization.
Alternative explanations for myocardial injury, including coronary vasospasm, microvascular dysfunction, and stress-related myocardial injury, cannot be completely excluded.

Implication

May warrant thyroid evaluation in myopericarditis; leaves open confirmation in prospective studies.

Abstract

Thyrotoxicosis-induced myopericarditis is an uncommon but increasingly recognized cardiovascular manifestation of Graves’ disease that may closely mimic acute coronary syndrome (ACS). We present a 42-year-old woman with obesity and tobacco use who presented with severe chest pain, ST-segment elevations, and elevated troponins concerning for acute coronary syndrome. Coronary angiography demonstrated non-obstructive coronary arteries, while further evaluation revealed severe thyrotoxicosis with impending thyroid storm and inflammatory findings consistent with myopericarditis. The patient was treated with anti-inflammatory therapy, antithyroid medications, beta-blockers, and corticosteroids with significant clinical improvement. This case highlights the importance of considering thyrotoxicosis-associated myopericarditis in patients presenting with myocardial injury and non-obstructive coronary arteries.

Discussion

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Cite This Study

Bhandari et al. (2026) conducted a case report in Thyrotoxicosis-induced myopericarditis (n=1). Anti-inflammatory and antithyroid therapy was evaluated on Symptom resolution and thyroid function improvement.

synapsesocial.com/papers/6a2e465cb1cc60ccdea8b188 https://doi.org/10.7759/cureus.110734

Topics

Takotsubo Syndrome

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Thyrotoxicosis-Induced Myopericarditis as the Initial Presentation of Graves’ Disease

Figures

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

Topics

Thyrotoxicosis-Induced Myopericarditis as the Initial Presentation of Graves’ Disease

Figures

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

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