Reversible Dilation of Chambers, Tricuspid Regurgitation and Pulmonary Hypertension in Patient with Hyperthyroidism: A Case Report

Author : Sepriyana, Haryadi
Upload Date : 19-04-2018

Background: Hyperthyroidism has been known to cause a variety of cardiovascular manifestations. Patient with hyperthyroidism having the signs or symptoms of right heart failure at presentation is a rarity. This case presentation emphasizes cardiovascular manifestations in the patient with hyperthyroidism especially pulmonary hypertension and dilation of chambers could get improvement through effective treatment.

Case: A 53 years old female presented with a 2 weeks shortness of breath on exertion. She also got pedal edema and ascites. Before those complained, she denied orthopnea or paroxysmal nocturnal dyspnea. She was a known cases of diabetes mellitus and hyperthyroidism. She got therapy for both condition but controlled unwell. When the first time she admitted in hospital vital sign was normal except irregular heart rate, any increased jugular vein pressure, there wasn’t rhonchi or wheezing in lung, any ascites and pedal edema. From laboratory we got HBA1C 7.30%, TSHs 0.05µIU/mL (0.4-4.2), free T4 63.89pmol/L (9.00-20.00). From ECG we got atrial fibrillation normal ventricular response, right ventricular hypertrophy, and ischemic in inferior. From Echocardiography (September, 2nd 2017) we got dilation of right atrium-right ventricle and left atrial (LAVi 74ml2), ejection fraction 73%, D shaped left ventricle, global normokinetic, moderate-severe tricuspid regurgitation (TVG 53mmHg), moderate pulmonary regurgitation (mPAP 45mmHg), another valve was normal. We diagnosed patient with secondary pulmonary hypertension due to hyperthyroidism, and preserved ejection fraction heart failure. Patient got therapy thiamazole 3x10mg, propranolol 3x10mg, aspirin 1x100mg, and insulin therapy. After four months she got therapy and controlled well, we didn’t find pedal edema, ascites, or increased jugular vein pressure, from laboratory FT4 5.63pmol/L, HBA1C 6.50%, from echocardiography (January, 2nd 2018) we didn’t get dilation of right atrium-right ventricle and left atrial (LAVi 28ml2), ejection fraction 74%, contractility of left ventricle and right ventricle were normal, there wasn’t D shaped left ventricle, tricuspid valve regurgitation trivial, pulmonary valve regurgitation trivial (mPAP 25mmHg).

Discussion: There are several cardiac manifestations of hyperthyroidism, including enlargement of the chambers, high output heart failure, and pulmonary hypertension. The association of those conditions is unwell established. In other study cardiac manifestations of hyperthyroidism are reversible condition, which getting effective treatment around several months till years.

Conclusion: Awareness of the possible presentation of hyperthyroidism may help identify patients with reversible dilated cardiomyopathy, preserved ejection fraction heart failure, and pulmonary hypertension.

KEYWORDS : hyperthyroidism, pulmonary hypertension, heart failure, dilated cardiomyopathy, reversible.

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