Graves’ Disease Induced Reversible Severe Right Heart Failure

Abstract

A middle aged man presented with evidence of right-sided heart failure in atrial fibrillation (AF) and was found to have severe Tricuspid Regurgitation (TR) with pulmonary artery hypertension (PAH), with normal left ventricular function. The common possible secondary causes of PAH were ruled out, but during investigation he was found to have elevated thyroid function tests compatible with the diagnosis of Graves' disease. The treatment of Graves' disease was started with anti-thyroid drugs and associated with a significant reduction in the pulmonary arterial pressure. This case report is presented to highlight one of the rare and underdiagnosed presentations of Graves' disease. Thyrotoxicosis can present with profound cardiovascular complications. In recent times, there have been few reports of secondary PAH with TR in patients with hyperthyroidism. Previously asymptomatic Graves' disease having the signs and symptoms of right heart failure is a rare presentation and the association could be easily missed. This case presentation emphasizes that the diagnosis of thyroid heart disease with heart failure secondary to Graves' disease should be considered in any patient regardless of age, gender with clinical features of heart failure of unknown etiology and timely initiation of anti-thyroid drugs is necessary to treat these reversible cardiac failures.

Cardiac manifestations in hyperthyroidism

“…In patients with heart failure and hyperthyroidism, in whom a causal relationship between the 2 is suspected, it is important to reevaluate cardiac function as thyroid function is corrected because as mentioned, structural and functional changes induced by hyperthyroidism can be reversible, making it necessary to also reevaluate the need for adjustments or withdrawal of the medication used for heart failure [ 67 , 72 , 75 , 78 , 79 ].…”