4 kg/m2. The patient discontinued use of loop diuretics (furosemide) but continued use of ACE inhibitor (enalapril), β-blockers (bisoprolol) and thyroid hormone replacement therapy. Fig. 1 Initial chest X-ray. A posteroanterior chest X-ray view shows cardiomegaly and both pleural effusions before treatment. Fig. 2 The 12-lead electrocardiography findings. On admission, the patient had normal sinus rhythm with low voltage of limb

leads, interventricular conduction delay and nonspecific ST-segment and T-wave Inhibitors,research,lifescience,medical changes. Fig. 3 Color Doppler of mitral regurgitation. A: Initial color Doppler findings. B: At a follow-up, there was no mitral regurgitation. Fig. 4 A fine-needle aspiration biopsy findings. A fine-needle aspiration Inhibitors,research,lifescience,medical biopsy of the nodule shows adenomatous hyperplasia in a background of lymphocytic thyroiditis (Papanicolaou’s stain, × 450). Fig. 5 Follow-up chest X-ray. At a follow-up, a posteroanterior chest X-ray view shows normalized heart size at 16 months after thyroid hormone supplementation and heart failure treatment. Table 1 Echocardiographic findings with TSH levels Discussion Hypothyroidism is associated with decreased cardiac

contractility, increased systemic vascular resistance and decreased cardiac output. Its manifestations are insidious and subtle in Inhibitors,research,lifescience,medical its progression and clinical behavior.4) DCM, the most common form of cardiomyopathy, may be caused by various factors such as metabolic/endocrine disturbances, electrolyte imbalances, inflammation, infection, immune system disorders and toxins.10) Thyroid hormones act on the cardiac myocyte and peripheral vasculature. The genomic and non-genomic effects

of thyroid hormone are related to the cardiac Inhibitors,research,lifescience,medical function and cadiovascular hemodynamics.4) To explain their possible genomic selleck effects on the cardiovascular system, it has been proposed that they involved in the regulation of the mRNA transcription of genes associated with Inhibitors,research,lifescience,medical the contractile system.1) They have a non-genomic effects on the ionic channels of cardiomyocyte’s membrane.4) Patients with hypothyroidism present with cardiovascular manifestations such as bradycardia, decreased contractility of the myocardium, increased systemic peripheral vascular resistance and the pericardial effusion. Moreover, patients with hypothyroidism are Oxalosuccinic acid at increased risks of developing atherosclerosis and ischemic heart disease.11),12) It has been reported that the cardiac manifestations are associated with alterations in the expression of T3-mediated genes in patients with thyroid dysfunction.4) Patients with hypothyroidism are less likely to develop heart failure although their cardiac output is decreased. This is due to their lower degree of oxygen demand.13) In the current case, the patient had no family history of DCM. In addition, the patient also had no past history of alcohol abuse or history of other drug or substance addiction. The echocardiographic findings were suggestive of DCM.