Cardiogenic shock due to Takotsubo cardiomyopathy following thyroidectomy

Takotsubo cardiomyopathy is characterized by transient left ventricular dysfunction in the absence of atherosclerotic disease. A 63yr old female with multiple autoimmune disorders was admitted to intensive care unit with severe hypotension and hypoxic respiratory failure following total thyroidectomy.  During her evaluation, her 2D echocardiogram showed good basal contractions with severe mid and apical hypokinesia and an ejection fraction of 35%. Her coronary angiogram showed normal epicardial coronaries and evidence of apical ballooning suggestive of TCM. Its recognition is important for prognostic evaluation and treatment considerations. Furthermore, the relationship between autoimmunity and TCM needs to be evaluated further.