Case Report
Spinal Cord (2009) 47, 262–263; doi:10.1038/sc.2008.46; published online 13 May 2008
Thyrotoxic cardiomyopathy and encephalopathy in a paraplegic man
J H Frisbie1
1Department of Medicine, Harvard Medical School, Research Service, Boston Healthcare Center and Harvard Medical School, Boston, MA, USA
Correspondence: Dr JH Frisbie, Spinal Cord Injury Service (128), Veterans Administration Hospital, 1400 VFW Parkway, MA 02132, USA. E-mail: jfrisbie@comcast.net
Received 10 January 2008; Revised 20 March 2008; Accepted 10 April 2008; Published online 13 May 2008.
Abstract
Study design:
Case report.
Background/objective:
Thyrotoxicosis complicating spinal cord injury is more common than generally appreciated. To raise the level of awareness, the following case of fatal thyrotoxicosis is presented.
Case report:
A 77-year-old man, paralyzed at the T12 level for 46 years, developed a sudden 42 lb weight loss, dyspnea, interscapular pain, 120/40 mm Hg blood pressure, a nodular thyroid gland, atrial fibrillation, progressive cardiac enlargement, left ventricular ejection fraction diminishing from 30 to 10% and a persistently low level of thyrotropic hormone, 0.05–0.2 
U ml-1 (normal 0.35–5.5 U ml-1). As coronary artery bypass grafting had been carried out 6 years earlier and other signs of thyrotoxicosis—exophthalmos, lid lag, sweating, tremor and diarrhea—were absent, recurrent arteriosclerotic heart disease was assumed and a trial of thyroid suppression not attempted. He eventually developed depression and memory loss and died in heart failure after a 4-year course of this illness.
Conclusion:
This case probably represented a toxic multinodular goiter in an elderly paraplegic man with potentially treatable cardiovascular and nervous system complications.
Keywords:
thyrotoxicosis, cardiomyopathy, encephalopathy, spinal cord injuries
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