Thyroid Storm with Heart Failure Treated with a Short-acting Beta-adrenoreceptor Blocker, Landiolol Hydrochloride

Yugo Yamashita, Moritake Iguchi, Rieko Nakatani, Takeshi Usui, Daisuke Takagi, Yasuhiro Hamatani, Takashi Unoki, Mitsuru Ishii, Hisashi Ogawa, Nobutoyo Masunaga, Mitsuru Abe, Masaharu Akao
2015 Internal medicine (Tokyo. 1992)  
Beta-adrenoreceptor blockers are essential in controlling the peripheral actions of thyroid hormones and a rapid heart rate in patients with thyroid storm, although they should be used with great caution when there is the potential for heart failure. A 67-year-old woman was diagnosed as having thyroid storm in addition to marked tachycardia with atrial fibrillation and heart failure associated with a reduced left ventricular function. The administration of an oral beta blocker, bisoprolol
more » ... r, bisoprolol fumarate, induced hypotension and was not tolerable for the patient, whereas landiolol hydrochloride, a short-acting intravenous beta-adrenoreceptor blocker with high cardioselectivity and a short elimination half-life, was useful for controlling the patient's tachycardia and heart failure without causing hemodynamic deterioration. A 67-year-old woman had been diagnosed with Graves' disease 20 years previously and followed with an antithyroid drug, thiamazole, by her general practitioner. She had no past medical history of paroxysmal atrial fibrillation. Two months before the current admission, she visited another hospital, where she was diagnosed with hypothyroidism and received thyroid hormone replacement therapy. However, she subsequently developed general fatigue and palpitations Abstract in English). 21. Mizunoya K, Maruyama T, Fujii T, et al. Anesthetic and perioperative management of a patient with uncontrolled thyrotoxicosis undergoing coronary artery bypass grafting surgery. Masui (Japanese Journal of Anesthesiology) 62: 1214-1217, 2013 (in Japanese, Abstract in English). 22. Nagai R, Kinugawa K, Inoue H, et al. Urgent management of rapid heart rate in patients with atrial fibrillation/flutter and left ventricular dysfunction: comparison of the ultra-short-acting β1selective blocker landiolol with digoxin (J-Land Study). Circ J 77: 908-916, 2013. 23. Kobayashi S, Murakami W, Myoren T, et al. A low-dose β1blocker effectively and safely slows the heart rate in patients with acute decompensated heart failure and rapid atrial fibrillation. Cardiology 127: 105-113, 2014. 2015 The Japanese Society of Internal Medicine
doi:10.2169/internalmedicine.54.3138 pmid:26134196 fatcat:u7ypbke5izdutn5sww7ncptb7y