This is a case of a 68-year-old man who was diagnosed late with Hashimoto’s thyroiditis
following a few admissions for symptomatic anaemia. Although hypothyroidism is common
among the elderly, the classic symptoms are less likely to be evident and anaemia can be the
first sign of hypothyroidism. This patient had multiple comorbidities including ischaemic heart
disease, diabetes and chronic kidney disease which might have contributed to the delay in
finding the underlying cause of his anaemia. He initially presented with symptomatic anaemia
and received blood transfusions and iron supplementation. On subsequent follow up, his
anaemia failed to improve. He was then referred to our primary care clinic. Hashimoto’s
thyroiditis was diagnosed based on his clinical features, thyroid function test results and antithyroid peroxidase level. This case highlights the importance of determining the cause of
anaemia as his haemoglobin level improved significantly after thyroxine was commenced. It
also serves as a reminder that hypothyroidism should be considered in patients with anaemia,
especially in those with uncertain aetiology.
Introduction: Sudden cardiac death is the most common medical cause of death in athletes.
The aim of this study was to identify the electrocardiogram (ECG) pattern changes and its
association with echocardiography among Malaysian footballers during a pre-participation
evaluation (PPE). Methods: A retrospective study was conducted on footballers attending a
PPE at a primary care centre. Secondary data collection was conducted and the proforma
included clinical history, physical examination, ECG, Echocardiogram and cardiovascular risk
factors assessment such as heart rate, blood pressure, lipid profile, fasting blood sugar and
creatinine. Data were extracted from the medical records, echocardiogram report and the
original ECG. The ECG patterns were analysed according to the International consensus for
ECG interpretation in athletes to determine physiological versus pathological changes. The
data was analysed using SPSS v24. Results: This study included 85 male Malaysian
footballers with a mean age of 20.1 ± 3.0 years. The mean resting heart rate was 55.2 ± 9.3
beats per minute. Abnormal ECG changes were found in 20% of the participants, which were
higher compared to that reported in other studies (14% – 17.3%). The normal ECG findings in
athletes were sinus bradycardia (76.5%), J-point elevation (68.2%), prolonged PR interval
(3.5%) and incomplete right bundle branch block (4.7%). The abnormal ECG changes were
multiple T wave inversions (5.9%), hypertrophy (2.4%), and deep Q-waves (8.2%). Four
abnormal ECGs were consistent with abnormal echocardiography findings and out of these,
two ECGs with hypertrophic changes were consistent with mild inter atrial septal bulging and
apical hypertrophy. Conclusions: Malaysian footballers have ECG changes that are
consistent with physiological changes in athlete’s heart. The positive association between ECG
and Echocardiogram findings are useful in confirming pathological ECG changes. Physicians
should be trained in PPE protocol and ECG interpretation in athletes in order to improve
identification of those at risk of sudden cardiac death.