Total Thyroidectomy for Heart Failure: An Unusual Case

Congestive cardiac failure associated with thyrotoxicosis is almost always relieved by sub-total thyroidectomy. It is probable that the improvement in the cardiac condition can be attributed to two distinct factors: first, to the removal of a direct toxic action of the thyroid secretion on the heart, and, secondly, to the removal of the burden of an augmented circulation rate that the increased metabolism of thyrotoxicosis places upon the heart. The direct effect of the thyroid on the heart is evident in the common association of auricular fibrillation with thyrotoxicosis and in the frequency with which normal rhythm is restored in such cases after sub-total thyroidectomy. The close connection between thyrotoxicosis and auricular fibrillation is also seen in the common occurrence of the latter in the first two days after thyroidectomy -a time when all the manifestations of thyrotoxicosis are generally at their height.