A Case of Takotsubo syndrome after Surgery for Papillary Thyroid Cancer
The patient was an 82-year-old woman undergoing treatment for bronchial asthma. In December 200X, she visited her former doctor because of a left cervical mass and pain, and was referred to our hospital for detailed examination. A 19-mm mass was found in the left lobe of the thyroid gland and there were many swollen lymph nodes on both sides of her neck. Fine-needle aspiration cytology revealed malignant and papillary cancer in both the left lobe and left cervical lymph node, but no lung metastasis was found in chest CT, and it was judged to be T1bN1bM0 Stage IVa. Total thyroidectomy + bilateral cervival lymphnode dissection was performed. The left lobe mass of the thyroid gland invaded the sterno-thyroid muscle, but no infiltration to other organs, including the lymph nodes on both sides, was observed. On the night of the operation, wheezing, dyspnea, lower mandibular breathing, and impaired consciousness suddenly developed, and the oxygen saturation of peripheral artery (SpO2) decreased to 60%. No postoperative bleeding was observed. Chest CT demonstrated no signs of heart failure, but based on thickening of the bronchial wall, the cause of hypoxemia was considered to be bronchial asthma. Steroids and oxygen (high-dose, 15 L/min) were administered, but respiratory acidosis developed and non-invasive positive pressure ventilation (NIPPV) was started. The respiratory condition gradually improved thereafter. Acute coronary syndrome (ACS) was suspected based on symptoms, increased troponin T, and ST elevation on ECG. Echocardiography revealed akinesis and left ventricular apical and basal hypercontractility. No coronary arterial stenosis was noted on coronary angiography and left ventriculography demonstrated Takotsubo-like wall movement (hypercontraction of the base and contraction failure of the apex), leading to a diagnosis of Takotsubo syndrome (TS). The subsequent course was good and she was discharged on the 10th postoperative day.