Endocrine Abstracts

Introduction: The auto immune’s diseases are also involved in the heart’s failure. Grave disease(GD) is an autoimmune thyroid disease that often linked by pericarditis. We report a case of an acute pericarditis that was also presumed to be associated with GD.

Case report: A 59 years old who 10 pack years smoker. admitted for chest pain and shortness breathstage 3NYHA. At the investigation there was a progessive emaciation of 12 kg within 7 months with palpitations and repeated diarrhea. 4 days ago he presented a progressive setting dyspnea with orthopnea with intense chest pain. At the examination, skinny patient, radiance to the eye. There was a homogeneous thyroid enlargement with thrill and neck vein engorgement. There was no foot ‘s oedema,pulse rate of 109 beats per minute and a normal blood pression at 120/80 The heartbeat was regular and no cardiac murmur including precordial friction rub could be identified. Laboratory results showed a stunted TSH at 0,005 µg/ml( ), T4L: 70 pmol/l(12–22), a neck echography hypervascularized with a homogeneous goiter, the thyroid’s antibody were positive by anti RTSh on 38(N<1.75). Transthoracic echocardiography showed circumferential effusion with hemodynamic consequences. The blood count and liver’s enzymes were normal and the remaining part of the immunologic and serology is featureless. The management consisted in 3 pericardial drainage and etiological treatment under ATS in offensive trend of 60 mg of carbimazole, propranolol 40 mg ½ cp*3/d.

The favorable development with the pericardium drying and clinic stabilization and biological and hyperthyroidicism.

Discussion: The pericarditis with effusion in GD can happen by autoimmune mechanism involving a direct or indirect interaction between the Ac anti receptor and the pericardium. The thyrotoxicosis affects the metabolism of the pericardial’s brown fat. The well taken ATS treatment must be completed by a radical treatment because of the high recidivism risk. The ATS choice is crucial because of pericarditis drug risk due to PTU.

Conclusion: The etiology research to a pericarditis must always involve a thyroid check not just to a research of a hypothyroidism commonly associated but also a hyperthyroidism notably in more frequently form which is the GD.