Clinical Case Report: Hypertension, Hypothyroidism and Sinus Bradycardia in a Middle-Aged Woman

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Clinical Case Report: Hypertension, Hypothyroidism and Sinus Bradycardia

1. Patient Profile

  • Age/Sex: 54–55 years / Female
  • Relevant Medical History: Hypertension and hypothyroidism
  • Other Clinical Finding: Sinus/physiological bradycardia

2. Clinical Presentation and Timeline

08 February 2024 – Acute Backache

The patient presented with acute backache following weight lifting approximately three days earlier. Movements were painful. Hypothyroidism and bradycardia were documented.

Treatment prescribed:

  • Voveran 50 mg (diclofenac)
  • Rantac (ranitidine)
  • Celebrex (celecoxib)
  • Multivitamins
  • Bed rest was advised.

24 February 2024 – 2D Echocardiography

2D echocardiography showed:

  • Global LVEF: 60%
  • Grade I left ventricular diastolic dysfunction
  • Mild aortic regurgitation
  • Normal right atrial and right ventricular size and function.

26–29 February 2024 – Hypertension and Bradycardia

The patient had a known history of hypertension and was receiving treatment. Sinus bradycardia was documented.

  • BP on 26 February: 130/90 mmHg
  • BP on 29 February: 130/80 mmHg

Treatment:

  • Thyronorm 75 mcg OD BBF (levothyroxine)
  • Rampace (ramipril)
  • Evion (vitamin E)
  • Spinal exercises were advised.

24–25 March 2024 – Hypertensive Urgency

On 24 March, the patient experienced an episode of markedly elevated blood pressure, recorded at 180/100 mmHg, consistent with a hypertensive urgency episode in the clinical record.

On follow-up the next day, BP had improved to 130/70 mmHg.

Treatment:

  • Amlopres 5 mg OD (amlodipine)
  • ASA-AV 75/20 mg HS (aspirin + atorvastatin)
  • Thyronorm 75 mcg (levothyroxine)

09–14 May 2024 – Follow-up

The patient reported no fresh complaints.

BP remained controlled:

  • 130/80 mmHg
  • 120/70 mmHg

The levothyroxine dose was adjusted to:

  • Thyronorm 62.5 mcg OD BBF (levothyroxine)

Antihypertensive treatment was continued.

03 June 2024 – Dyspepsia

The patient reported dyspepsia.

  • BP: 110/70 mmHg

Treatment:

  • Telma 40 mg + hydrochlorothiazide (telmisartan + hydrochlorothiazide)
  • Pan-D (pantoprazole + domperidone)

Daily BP monitoring was advised.

13–18 June 2024 – Symptomatic Improvement

The patient reported complete relief from symptoms.

  • BP: 120/80 mmHg

Levothyroxine was further reduced to:

  • Thyronorm 50 mcg OD BBF (levothyroxine)

Telmisartan and the previously prescribed aspirin/atorvastatin combination were continued.

03 August 2024 – Medication Adjustment

  • BP: 120/80 mmHg

Medication was adjusted to:

  • Telma 20 mg OD (telmisartan)
  • Thyronorm 50 mcg OD (levothyroxine)
  • Amlopres 10 mg HS (amlodipine)

September–November 2024 – Stable Follow-up

BP remained generally controlled, ranging from 110/70 to 120/80 mmHg.

The established treatment regimen was continued.

23 November 2024 – Chronic Disease Follow-up

The clinical record documented:

  • Hypothyroidism
  • Hypertension
  • Physiological bradycardia
  • BP: 110/70 mmHg

Continued treatment:

  • Thyronorm 50 mcg (levothyroxine)
  • Telma 40 mg (telmisartan)
  • Amlopres 10 mg (amlodipine)
  • ASA-AV (aspirin + atorvastatin)

January–February 2025 – Follow-up

The patient reported no fresh complaints.

Blood pressure readings included:

  • 140/90 mmHg
  • 140/80 mmHg

ECG demonstrated sinus bradycardia with a heart rate of 44 beats/minute.

Thyroid function testing was documented as normal.

3. Investigations

2D Echocardiography

  • LVEF: 60%
  • Grade I LV diastolic dysfunction
  • Mild aortic regurgitation
  • Normal right-sided cardiac chamber size and function

Electrocardiography

  • Sinus bradycardia
  • Heart rate: 44 beats/minute

Thyroid Function Testing

  • TFT reported as normal during the January–February 2025 follow-up.

4. Clinical Summary

This case describes a middle-aged female with hypertension and hypothyroidism, followed over approximately one year. During follow-up, she experienced an episode of markedly elevated blood pressure, while subsequent visits generally demonstrated controlled blood pressure on antihypertensive therapy.

Cardiac evaluation showed preserved left ventricular systolic function (LVEF 60%), Grade I diastolic dysfunction, and mild aortic regurgitation. Persistent sinus bradycardia, including a heart rate of 44 beats/minute on ECG, was documented. Thyroid function was subsequently reported as normal despite continued levothyroxine therapy.

The patient also experienced separate episodes of acute backache, dyspepsia during the follow-up period, which were managed accordingly.

 

Medical Disclaimer: The information provided in this article is strictly for educational, study, and exam-preparation purposes. It does not constitute professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider for clinical decisions.

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