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An Unusual Manifestation of Hyperthyroidism
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A6992 - An Unusual Manifestation of Hyperthyroidism
Author Block: P. Sharma, M. Suffoletto; UPMC Mercy, Pittsburgh, PA, United States.
Introduction:
Hyperthyroidism is a common endocrine disorder with many systemic and cardiovascular manifestations. Increased circulating thyroid hormones lead to increased adrenergic stimulation and cardiac complications like atrial fibrillation and congestive heart failure. We report a case of a 66-year-old female who presented with pulmonary hypertension secondary to hyperthyroidism.
Case Description:
66-year-old female with history of hypertension presented for evaluation of dyspnea on exertion and weight loss. She also endorsed anxiety, fatigue, diarrhea, tremors and occasional palpitations. Echocardiogram showed normal left ventricular thickness and function, mild right ventricular hypertrophy with normal function. Right ventricular systolic pressure of 40-45 mmHg, and no pulmonary valvular regurgitation. Cardiac catheterization showed moderate pulmonary hypertension 55/22 with mean of 32 mmHg, mean pulmonary artery wedge pressure 18 mmHg. Laboratory investigations showed high T4, low TSH, and positive thyroid stimulating immunoglobulins (TSI) consistent with Grave’s disease. Methimazole was initiated, however she developed an adverse drug reaction and subsequently had to undergo thyroidectomy. Repeat echocardiogram after treatment of hyperthyroidism showed resolution of pulmonary hypertension with PA systolic pressure 35 mmHg.
Discussion:
Hyperthyroidism is a hyper-dynamic state that can lead to various cardiovascular manifestations due to its inotropic and chronotropic effects. Hyperthyroidism is a commonly overlooked etiology of pulmonary hypertension (PH). PH due to thyroid disorders is classified into group-5 PH (due to multifactorial mechanisms). Sugiura et al studied fifty patients with Grave’s disease and demonstrated thyroid receptor antibodies to be associated with PH, thus underlying a potential autoimmune pathogenesis in PH in Grave’s disease. Studies have shown PH due to hyperthyroidism reverses after treatment and attaining euthyroid state. Hyperthyroidism can lead to pulmonary hypertension, and subsequently tricuspid regurgitation with right heart failure. It is prudent to consider hyperthyroidism and PH as a differential for isolated right heart failure. Lozano and Sharma reported a case of pulmonary hypertension and right heart failure associated with Grave’s disease with symptoms resolving after treatment. This case underlines the importance of hyperthyroidism as an important cause of reversible pulmonary hypertension.
Author Block: P. Sharma, M. Suffoletto; UPMC Mercy, Pittsburgh, PA, United States.
Introduction:
Hyperthyroidism is a common endocrine disorder with many systemic and cardiovascular manifestations. Increased circulating thyroid hormones lead to increased adrenergic stimulation and cardiac complications like atrial fibrillation and congestive heart failure. We report a case of a 66-year-old female who presented with pulmonary hypertension secondary to hyperthyroidism.
Case Description:
66-year-old female with history of hypertension presented for evaluation of dyspnea on exertion and weight loss. She also endorsed anxiety, fatigue, diarrhea, tremors and occasional palpitations. Echocardiogram showed normal left ventricular thickness and function, mild right ventricular hypertrophy with normal function. Right ventricular systolic pressure of 40-45 mmHg, and no pulmonary valvular regurgitation. Cardiac catheterization showed moderate pulmonary hypertension 55/22 with mean of 32 mmHg, mean pulmonary artery wedge pressure 18 mmHg. Laboratory investigations showed high T4, low TSH, and positive thyroid stimulating immunoglobulins (TSI) consistent with Grave’s disease. Methimazole was initiated, however she developed an adverse drug reaction and subsequently had to undergo thyroidectomy. Repeat echocardiogram after treatment of hyperthyroidism showed resolution of pulmonary hypertension with PA systolic pressure 35 mmHg.
Discussion:
Hyperthyroidism is a hyper-dynamic state that can lead to various cardiovascular manifestations due to its inotropic and chronotropic effects. Hyperthyroidism is a commonly overlooked etiology of pulmonary hypertension (PH). PH due to thyroid disorders is classified into group-5 PH (due to multifactorial mechanisms). Sugiura et al studied fifty patients with Grave’s disease and demonstrated thyroid receptor antibodies to be associated with PH, thus underlying a potential autoimmune pathogenesis in PH in Grave’s disease. Studies have shown PH due to hyperthyroidism reverses after treatment and attaining euthyroid state. Hyperthyroidism can lead to pulmonary hypertension, and subsequently tricuspid regurgitation with right heart failure. It is prudent to consider hyperthyroidism and PH as a differential for isolated right heart failure. Lozano and Sharma reported a case of pulmonary hypertension and right heart failure associated with Grave’s disease with symptoms resolving after treatment. This case underlines the importance of hyperthyroidism as an important cause of reversible pulmonary hypertension.
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