• Acute myocarditis
• Graves' disease
• Hyperthyroidism, Cardiothyreosis
• Hyperthyroïdie, Cardiothyréose
• Maladie de Basedow
• Myocardite aiguë

• Humans
• Myocarditis/etiology
• Female
• Graves Disease/complications
• Graves Disease/drug therapy
• Adult
• Acute Disease
• Antithyroid Agents/therapeutic use
• Electrocardiography

• Graves’ disease
• heart failure
• hyperthyroidism
• prevalence
• risk factors
• treatment

• Infections
• Interventional cardiology
• Thyroid disease

• Humans
• Myocarditis/virology
• Myocarditis/diagnosis
• Coxsackievirus Infections/complications
• Coxsackievirus Infections/diagnosis
• Enterovirus B, Human
• Graves Disease/complications
• Male
• Chest Pain/etiology
• Adult
• Electrocardiography
• Antithyroid Agents/therapeutic use
• Acute Disease
• Coronary Vasospasm/complications
• Coronary Vasospasm/diagnosis
• Middle Aged

• Mitral regurgitation
• systematic review
• thyrotoxic valvulopathy
• thyrotoxicosis
• tricuspid regurgitation

• Graves` disease
• acute coronary syndrome
• heart failure
• myocarditis

• cardiomyopathy
• myocarditis
• thyroid storm
• thyrotoxicosis

• Coronary artery spasm
• Graves' disease
• SARS-CoV-2 vaccination
• ST-elevation
• myocarditis
• selective 5-hydroxytryptamine type 1 receptor agonist

• Male
• Humans
• Middle Aged
• Serotonin
• Sumatriptan
• Myocarditis/diagnosis
• Myocarditis/etiology
• RNA, Viral
• 2019-nCoV Vaccine mRNA-1273
• COVID-19 Vaccines/adverse effects
• Coronary Vasospasm
• COVID-19/diagnosis
• SARS-CoV-2
• Graves Disease/diagnosis
• Vaccination

• Adaptive immunity
• Autoantibodies
• Autoimmunity
• Autoreactive T-cells
• COVID-19 infection
• COVID-19 mRNA vaccine
• Inflammation
• Innate immunity
• Myocarditis
• Spike protein

• Humans
• COVID-19/epidemiology
• COVID-19/prevention & control
• COVID-19 Vaccines/adverse effects
• mRNA Vaccines
• Myocarditis/epidemiology
• Myocarditis/etiology
• Pericarditis
• RNA, Messenger
• Vaccination

Acute myocarditis is an acute myocardium injury that manifests as arrhythmia, dyspnea, and elevated cardiac enzymes. Acute myocarditis is usually caused by a viral infection but can sometimes be caused by autoimmunity. Graves’ disease is an autoimmune disease that is a rare etiology of acute myocarditis. Accelerated junctional rhythm is also a rare manifestation of acute myocarditis in adults.

A rare case of new-onset Graves’ disease combined with acute myocarditis and thyrotoxic periodic paralysis is reported. The patient was a 25-year-old young man who suddenly became paralyzed and felt palpitations and dyspnea. He was then sent to our emergency department (ED). Upon arrival, electrocardiography revealed an accelerated junctional rhythm and ST-segment depression in all leads, and laboratory findings showed extreme hypokalemia and elevated troponin I, with the troponin I level being 0.32 ng/mL (reference range, 0-0.06 ng/mL). Coronary computer tomography angiography was performed, and there were no abnormal findings in the coronary arteries. Subsequently, the patient was admitted to the ED ward, where further testing revealed Graves’ disease, along with continued elevated cardiac enzyme levels and B-type natriuretic peptide (BNP) levels. The troponin I level was 0.24 ng/mL after admission. All of the echocardiography results were normal: Left atrium 35 mm, left ventricle 48 mm, end-diastolic volume 102 mL, right atrium 39 mm × 47 mm, right ventricle 25 mm, and ejection fraction 60%. Cardiac magnetic resonance was performed on the fifth day of admission, revealing myocardial edema in the lateral wall and intramyocardial and subepicardial late gadolinium enhancement in the lateral apex, anterior lateral, and inferior lateral segments of the ventricle. The patient refused to undergo an endomyocardial biopsy. After 6 d, the patient’s cardiac enzymes, BNP, potassium, and electrocardiography returned to normal. After the patient’s symptoms were relieved, he was discharged from the hospital. During a 6-mo follow-up, the patient was asymptomatic and subjected to thyroid function, liver function, kidney function, troponin I, and electrocardiograph routine tests for medicine adjustments. The hyperthyroid state was controlled.

Acute myocarditis is a rare manifestation of Graves’ disease. Accelerated junctional rhythm is also a rare manifestation of acute myocarditis in adults. When the reason for hypokalemia and elevated cardiac enzymes in patients is unknown, cardiologists should consider Graves’ disease and also pay attention to accelerated junctional rhythm.

• Graves’ disease
• Myocarditis
• Thyrotoxic periodic paralysis
• Accelerated junctional rhythm
• Case report

Radix Scrophulariae (Chinese name: Xuanshen), a traditional Chinese herb, is used for the treatment of hyperthyroidism, and in this study, its mechanisms were evaluated by metabonomics and system pharmacology. To study the anti-hyperthyroidism effects of R. Scrophulariae, a male SD rat (180–220 g) model of hyperthyroidism induced by Euthyrox was used. Thirty rats were randomly distributed into three groups: the Model group, the R. Scrophulariae treatment group (RS group) and the healthy Control group. Using the UHPLC/Q-TOF-MS metabolomics approach, 44 metabolites were found to be profoundly altered in the model group, and the levels of these biomarkers were significantly decreased after treatment with R. Scrophulariae. Forty-four metabolites and 13 signaling pathways related to R. Scrophulariae, including the biosynthesis of unsaturated fatty acids, primary bile acid biosynthesis and sphingolipid metabolism, were explored, and linoleic acid metabolism and sphingolipid metabolism were identified as the most relevant metabolic pathways. In addition, the system pharmacology paradigm revealed that R. Scrophulariae contains 83 active ingredients and is related to 795 genes, and 804 disease genes are related to hyperthyroidism. The construction of the R. Scrophulariaceae-chemical composition-target-hyperthyroidism network identified a total of 112 intersection genes. The enriched gene targets were analyzed, and five pathways were found to be enriched. Among them pathways, the HIF signaling pathway had the highest enrichment score, which indicated that this pathway might be the main signaling pathway related to the treatment of hyperthyroidism by R. Scrophulariae.The integrated approach involving metabolomics and network pharmacology revealed that R. Scrophulariae might play a role in the treatment of hyperthyroidism by regulating the “IL6-APOA1-cholesterol” pathway and disturbing the HIF signaling pathway. The results demonstrate that the combination of metabolomics and network pharmacology could be used to reflect the effects of R. Scrophulariae on the biological network and metabolic state of hyperthyroidism and to evaluate the drug efficacy of R. Scrophulariaceae and its related mechanisms.

• hyperthyroidism
• mechanism of action
• metabonomics
• network pharmacology
• radix scrophulariae

Hyperthyroidism is commonly associated with adverse cardiovascular effects, including tachydysrhythmia, heart failure, and hypertension, although the association between hyperthyroidism and myopericarditis is restricted to a small number of case reports.

A 45-year-old Caucasian male with no past medical history was admitted with chest pain. The electrocardiogram demonstrated diffuse ST-segment elevation, the troponin T rose, and he was diagnosed with myopericarditis. He was noted to have markedly deranged thyroid function tests and a diagnosis of hyperthyroidism secondary to Graves’ disease was made. He was treated with Bisoprolol, Carbimazole, Prednisolone, Ibuprofen, and Colchicine, his symptoms resolved rapidly and he was discharged. Five weeks later he re-presented with similar symptoms and recurrent pericarditis was diagnosed. His symptoms settled with a repeat course of steroids.

We hypothesize that there may be an underappreciated link between hyperthyroidism and myopericarditis. Potential pathophysiological mechanisms include viral infection, autoimmunity, or changes in myocardial fat metabolism. Suggested management consists of a combination of current guidelines for the treatment of hyperthyroidism and pericardial disease, with attention to certain disease–drug interactions. Further research is required to evaluate the true incidence of hyperthyroidism-associated myopericarditis, elucidate its pathophysiology and instruct management.

• Case report
• Hyperthyroidism
• Myocarditis
• Pericarditis
• Thyroiditis

The manifestations of hyperthyroidism-related myocardial damage are multitudinous, including arrhythmia, dilated cardiomyopathy, valvular diseases, and even cardiogenic shock. Acute myocarditis induced by thyrotoxicosis had been reported in a few studies. However, attention on its prevalence and underlying mechanisms is sorely lacking. Its long-term harm is often ignored, and it may eventually develop into dilated cardiomyopathy and heart failure. We report a case of Graves' disease with a progressive elevation of hypersensitive cardiac troponin-I at several days after discontinuation of the patient's anti-thyroid drugs. Cardiac magnetic resonance imaging (CMRI) showed inflammatory edema of some cardiomyocytes (stranded enhanced signals under T2 mapping), myocardial necrosis (scattered enhanced signals under T1 late gadolinium enhancement) in the medial and inferior epicardial wall, with a decreased left ventricular systolic function (48%), which implied a possibility of acute myocarditis induced by thyrotoxicosis. The patient was then given a transient glucocorticoid (GC) treatment and achieved a good curative effect. Inspired by this case, we aim to systematically elaborate the pathogenesis, diagnosis, and treatment of hyperthyroidism-induced autoimmune myocarditis. Additionally, we emphasize the importance of CMRI and GC therapy in the diagnosis and treatment of hyperthyroidism-related myocarditis.

• Graves' disease
• autoimmune myocarditis
• cMRI
• glucocorticoid
• thyrotoxicosis

• cardiovascular medicine
• emergency medicine
• endocrine system

We present the case of a 38-year-old male with a history of acute chest pain associated with electrocardiographic ST-segment elevation and levels of myocardial damage markers. Few studies have evaluated chest pain and elevated troponin T during subacute thyroiditis. To the best of our knowledge, this is the reported case of myopericarditis associated with increased thyroid hormones in the bloodstream and accompanied by a significant increase in troponin T and cardiac magnetic resonance imaging findings of myopericarditis during the acute phase of subacute thyroiditis.

The effects of hyperthyroidism on the heart are well documented, primarily consisting of supraventricular tachycardias, congestive heart failure, and dilated cardiomyopathy. Acute myopericarditis resulting from a hyperthyroid state is an uncommon but recognized association.

A 29-year-old man with a history of Graves’ disease presented with chest pain and electrocardiogram changes suggestive of an infero-lateral ST-elevation myocardial infarction. However, emergent coronary angiography and bedside echocardiography were normal. Troponin-I was found to be >25 000 ng/L (normal value <57). Thyroid function tests showed a significantly raised free T4 and undetectable thyroid-stimulating hormone. Cardiovascular magnetic resonance (CMR) showed extensive myocardial oedema and late gadolinium enhancement (LGE) in keeping with acute myopericarditis, alongside an enlarged thyroid gland consistent with goitre. Propylthiouracil in combination with an angiotensin-converting enzyme inhibitor and beta-blocker were commenced and eventually definitive treatment with thyroidectomy was performed. Follow-up CMR at 6 months showed complete resolution of the prior noted oedema and a reduction in the location and extent of LGE with significant residual fibrosis.

Acute myopericarditis is a common diagnosis in young patients presenting with symptoms of chest pain with elevated troponin and is frequently related to a viral illness. Hyperthyroid states are also associated with acute myopericarditis and should be particularly considered in patients with a pre-existing thyroid condition or in those with symptoms suggestive of hyperthyroidism. Given the specific treatments required in a case of myopericarditis associated with hyperthyroidism, it is important to be aware of this association and consider screening where appropriate.

• Case report
• Graves’
• MINOCA
• Myopericarditis
• Thyrotoxicosis
• disease