Abstract
Cardiac failure is an uncommon complication of juvenile hyperthyroidism. We describe an adolescent boy with Graves' disease who developed manifestations of heart failure while on antithyroid medications. There was no evidence of any underlying cardiac disease. He had paradoxical euthyroid hormone profile which rose to hyperthyroid range when the manifestations of the cardiac failure subsided. The case highlights several unusual features of Graves' disease.
Highlights
Thyroid hormones have multiple effects on the cardiovascular system [1]
Hyperthyroidism has multiple effects on the cardiovascular system including decreased systemic vascular resistance and increased resting heart rate, left ventricular contractility and blood volume leading to a state of high cardiac output [1]
A small percentage of patients with hyperthyroidism may present with clinical manifestations of cardiac failure [2]
Summary
Thyroid hormones have multiple effects on the cardiovascular system [1]. many of the characteristic signs and symptoms of hyperthyroidism are cardiovascular, cardiac failure is seen only in up to 6% cases [2] and is more common in older age with underlying ischemic or hypertensive cardiomyopathy [1,2]. There are very few reports in the literature of cardiac failure in juvenile hyperthyroidism in the absence of underlying heart disease [3]. A state of cardiac failure is known to cause changes in the thyroid hormone profile, especially low total triiodothyronine (T3) [4,5]. Diaphoresis, tremors, polyphagia and weight loss were present for six months The echocardiogram showed mild pulmonary arterial hypertension, dilated right ventricle and tricuspid regurgitation with normal contractility of both the ventricles. Repeat T4 and free T4 rose to hyperthyroid levels (Table 1), with serum albumin of 31 g/L. He was given potassium iodide drops for further symptomatic improvement. In subsequent follow up he was diagnosed to have radio-iodine induced hypothyroidism requiring thyroxine replacement (Table 1)
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