Unraveling the cardiac consequences of hypothyroidism: a case report of sinus arrest and bradycardia exacerbated by seasonal changes, escitalopram and medication noncompliance

Thyroid hormone is essential in human metabolism. Hypothyroidism causes bradycardia, sinus pause, sinus arrest, and the most severe form, myxedema coma, and cardiopulmonary arrest. Most cardiovascular manifestations secondary to hypothyroidism are reversible with timely thyroid hormone replacement. Herein, we report a case of a 53-year-old woman with hypothyroidism who experienced episodes of prolonged sinus arrest, which resolved following temporary pacing and initiation of levothyroxine therapy. Factors such as seasonal variation, medication noncompliance, recent viral illness, and concurrent escitalopram use likely contributed to her presentation. This case highlights the importance of prompt recognition and management of hypothyroid-related cardiac arrhythmias.