Endocrine Abstracts

Introduction: Hyperthyroidism is a common endocrine disorder that is associated with prominent cardiovascular manifestations. Recent studies also suggest a potential link between hyperthyroidism and pulmonary hypertension (PH). Right-sided heart failure with clinical manifestation is only occasionally seen in patients with Graves’ disease. The prevalence and pathogenic mechanisms of hyperthyroidism-related PHT remain unclear but based on literary data an autoimmune mechanism associated with vascular endothelial damage appears to have played a key pathogenic role.

Case report: We present a case of 26 years old young woman with a relapse of Graves’ disease. She has been treated for hyperthyroidism in 2008 with antithyroid drugs for 2 years. Patient was admitted to our Department with a 1 month history of generalized weakness, palpitations and intolerance of physical activity, physical examination showed a marks of a right-sided heart failure, exophtalmus and diffuse enlargement of thyroid, ECG showed atrial fibrillation 200/irreg. Patient was treated for hyperthyroidism with propylthiouracyl (PTU) for 1 month (TDD 100 mg), treatment was accompanied with adverse effect on hemopoesis, patient had a pancytopenia. Thyroid state showed hyperthyroidism, TSH-receptor antibodies TRAb were 6.2 (RR 0–1 IU/l). Echocardiography showed reduced left ventricular function, moderate tricuspid regurgitation with pulmonary artery systolic pressure 90 mmHg. Tromboembolism as a reason of PH was excluded. Treatment with PTU was stopped and started a treatment with metimazol (TDD 30 mg), loop diuretics and katecholamines. After treatment we have observed improvement of laboratory findings, normalisation of EFLV, PH decreased. We observed regression of right-sided hearth failure. Definitive treatment of hyperthyroidism will be necessary after achievement of euthyroid state.

Conclusion: Graves’ disease may be one of the reason of cardiovascular complications, particularly atrial fibrillation, pulmonary hypertension and heart failure.