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Myocarditis associated with Hashimoto’s disease: a case report

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Abstract

We report on a sudden cardiac death case involving a 40-year-old man with no known medical history. Forensic autopsy showed lymphocytic myocarditis associated with lymphocytic thyroiditis. In both the heart and the thyroid gland, the inflammatory foci often had a nodular pattern with a germinal centre. Virological and toxicological analyses were negative. Postmortem biochemistry showed a slight increase in TSH in combination with normal T3 and T4 blood levels suggesting hypothyroidism. High titres of antiperoxidase and antithyroglobulin antibodies with normal levels of TSH receptor antibodies, in addition to biological hypothyroidism and lymphocytic inflammation were consistent with the diagnosis of Hashimoto’s thyroiditis. Immunohistochemical studies excluded a lymphoma and showed no evidence of viral myocarditis. In contrast to Grave’s disease, Hashimoto’s thyroiditis has never been reported in association with myocarditis as a cause of sudden death. We conclude that the cardiac immunological and histological pattern, similar to that found in the thyroid gland suggests an autoimmune myocarditis.

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References

  1. Feldman AM, McNamara D (2000) Myocarditis. New Engl J Med 343:1388–1398

    Article  CAS  PubMed  Google Scholar 

  2. Loire R (1999) La mort subite cardiovasculaire. Ann Pathol 19:203–211

    CAS  PubMed  Google Scholar 

  3. Pankuweit S, Portig I, Eckhardt H, Crombach M, Hufnagel G, Maisch B (2000) Prevalence of viral genome in endomyocardial biopsies from patients with inflammatory heart muscle disease. Herz 25:221–226

    Article  CAS  PubMed  Google Scholar 

  4. Edston E (1996) Three sudden deaths in men associated with undiagnosed chronic thyroiditis. Int J Legal Med 109:94–97

    CAS  PubMed  Google Scholar 

  5. Edston E, Druid H, Holmgren P, Öström M (2001) Postmortem measurements of thyroid hormones in blood and vitreous humor combined with histology. Am J Forensic Med Pathol 22:78–83

    Article  CAS  PubMed  Google Scholar 

  6. Coe JI (1973) Postmortem values of thyroxine and thyroid-stimulating hormones. J Forensic Sci 18:20–24

    CAS  PubMed  Google Scholar 

  7. Rachut E, Rynbrandt DJ, Doutt TW (1980) Postmortem behavior of serum thyroxine, trioiodothyronine, and parathormone. J Forensic Sci 25:67–71

    CAS  PubMed  Google Scholar 

  8. Simson LR (1976) Thyrotoxicosis: postmortem diagnosis in an unexpected death. J Forensic Sci 21:831–832

    PubMed  Google Scholar 

  9. Polikar R, Burger AG, Scherrer U, Nicod P (1993) The thyroid and the heart. Circulation 87:1435–1441

    CAS  PubMed  Google Scholar 

  10. Fatourechi V, Edwards WD (2000) Grave’s disease and low-output cardiac dysfunction: implications for autoimmune disease in endomyocardial biopsy tissue from eleven patients. Thyroid 10:601–605

    CAS  PubMed  Google Scholar 

  11. Nora ED, Flaxman N (1943) The heart in experimental thyrotoxicosis. J Lab Clin Med 28:797–808

    Google Scholar 

  12. Wright EA (1957) A case of malignant exophthalmos associated with a fatal myocarditis. Guy’s Hosp Rep 106:36–46

    Google Scholar 

  13. Letter EA de , Piette MHA, Lambert WE, Leenheer AP de (2000) Medico-legal implications of hidden thyroid dysfunction: a study of two cases. Med Sci Law 40:251–257

    PubMed  Google Scholar 

  14. Ortmann C, Pfeiffer H, Du Chesne A, Brinkmann B (1999) Inflammation of the cardiac conduction system in a case of hyperthyroidism. Int J Legal Med 112:271–274

    CAS  PubMed  Google Scholar 

  15. Saphir O (1942) Myocarditis. Arch Pathol 33:88–137

    Google Scholar 

  16. Nishida N, Ikeda N, Kudo K, Tsuji A, Kiyoshima A (2002) Forensic significance of conduction system abnormalities as a precise cause of accidental death. Int J Legal Med 116:344–349

    CAS  PubMed  Google Scholar 

  17. Baroldi G, Mittleman RE, Parolini M, Silver MD, Fineschi V (2001) Myocardial contraction bands. Definition, quantification and significance in forensic pathology. Int J Legal Med 115:142–151

    CAS  PubMed  Google Scholar 

  18. Dettmeyer R, Reith K, Madea B (2002) Alcoholic cardiomyopathy versus chronic myocarditis—immunohistological investigations with LCA, CD3, CD68 and tenascin. Forensic Sci Int 126:57–62

    Article  CAS  PubMed  Google Scholar 

  19. Edston E, Gröntoft L, Johnsson J (2002) TUNEL: a useful screening method in sudden cardiac death. Int J Legal Med 116:22–26

    PubMed  Google Scholar 

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Acknowledgements

The authors thank Diane Damotte, MD, PhD, haematopathologist, for her advice in immunohistochemical analyses.

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Authors and Affiliations

  1. Department of Pathology and Forensic Medicine, Raymond Poincaré Hospital, 104 Boulevard Raymond Poincaré, 92380 , Garches, France

    G. Lorin de la Grandmaison & F. Paraire

  2. Department of Radioisotopes, Necker Hospital, 149 rue de Sèvres, 75743, Paris, France

    M. Izembart

  3. Department of Pathology, European Georges Pompidou Hospital, 20 rue Leblanc, 75015, Paris, France

    P. Fornes

Authors
  1. G. Lorin de la Grandmaison
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  2. M. Izembart
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  3. P. Fornes
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  4. F. Paraire
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Correspondence to G. Lorin de la Grandmaison.

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Lorin de la Grandmaison, G., Izembart, M., Fornes, P. et al. Myocarditis associated with Hashimoto’s disease: a case report. Int J Legal Med 117, 361–364 (2003). https://doi.org/10.1007/s00414-003-0392-5

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  • DOI: https://doi.org/10.1007/s00414-003-0392-5

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