Isolated Right Heart Failure: A Rare Complication of Thyrotoxicosis

1Allegheny General Hospital Western Pennsylvania Hospital Medical Education Consortium, Pittsburgh, PA

Meeting: Hospital Medicine 2011, May 10-13, Dallas, Texas.

Abstract number: 329

Case Presentation:

A 40‐year‐old woman with recently diagnosed Graves’ disease and atrial fibrillation presented with a 3‐week history of abdominal distension, shortness of breath, and palpitations. She had associated diarrhea and a 20‐pound weight loss. Physical examination revealed a heart rate of 120 and blood pressure of 118/68. She had exophthalmos, diffuse nontender goiter, and jugular venous distension. She also had hepatomegaly and pedal edema. Electrocardiogram showed atrial fibrillation with a rate of 120. Labs were consistent with thyroid storm (TSH, < 0.005; T3, 602 ng/dL; FT4, 5.84 ng/dL). A transthoracic echocardiogram (TTE) showed left ventricle ejection fraction of 65%, severely dilated right ventricle with normal systolic function, and mild tricuspid regurgitation. She was treated with intravenous steroids, propylthiouracil, and potassium iodide. In addition, diuretics and beta‐blockers were given to manage her thyrotoxic heart failure. Subsequently, she underwent a total thyroidectomy and remained chemically and clinically euthyroid. A repeat TTE in the euthyroid state was normal, with complete resolution of right heart failure.

Discussion:

Right heart failure (RHF) is often accompanied by severe left heart failure. Isolated RHF occurs only occasionally, and its common causes are pulmonary hypertension, tricuspid regurgitation, and constrictive pericarditis. Thyrotoxicosis is an infrequently reported cause of isolated RHF. The mechanism by which thyrotoxicosis causes isolated RHF is not clear, and it can arise from a combination of factors: (1) increased blood volume can increase pulmonary arterial pressure and dilate the right ventricle; (2) excess thyroid hormone may cause a form of stunned myocardium predominantly involving the right ventricle; (3) thyroid autoantibodies secreted in Graves’ disease may injure the pulmonary endothelium, further contributing to pulmonary hypertension. These cardiac abnormalities in reported cases were characterized by the reversibility of the pathology and the benign clinical course once thyrotoxicosis was treated and patients became euthyroid.

Conclusions:

Isolated right heart failure is an important but rarely reported manifestation of thyrotoxicosis. When managing thyrotoxicosis patients, clinicians should be aware of this. Patients with isolated right heart failure should always be evaluated for thyrotoxicosis because it is a reversible condition.

Disclosures:

K. Machado ‐ none; R. Khehra ‐ none; M. Cratty ‐ none

To cite this abstract:

Machado K, Khehra R, Cratty M. Isolated Right Heart Failure: A Rare Complication of Thyrotoxicosis. Abstract published at Hospital Medicine 2011, May 10-13, Dallas, Texas. Abstract 329. Journal of Hospital Medicine. 2011; 6 (suppl 2). https://www.shmabstracts.com/abstract/isolated-right-heart-failure-a-rare-complication-of-thyrotoxicosis/. Accessed July 21, 2019.

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