Hyperthyroidism with Biventricular Heart Failure and Cirrhotic Transformation of the Liver
Cardiovascular symptoms remain the most common presenting features and leading causes of death in hyperthyroidism. We report a young female with reported thyroid disease and medication noncompliance presenting with atrial fibrillation, severe atrioventricular regurgitation, severely dilated right he...
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| Format: | Article |
| Language: | English |
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Wiley
2018-01-01
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| Series: | Case Reports in Cardiology |
| Online Access: | http://dx.doi.org/10.1155/2018/3861340 |
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| author | Rashmi Dhital Shivani Vyas Priyadarshani Sharma Theresa Lynn Oreoluwa Oladiran Sijan Basnet |
| author_facet | Rashmi Dhital Shivani Vyas Priyadarshani Sharma Theresa Lynn Oreoluwa Oladiran Sijan Basnet |
| author_sort | Rashmi Dhital |
| collection | DOAJ |
| description | Cardiovascular symptoms remain the most common presenting features and leading causes of death in hyperthyroidism. We report a young female with reported thyroid disease and medication noncompliance presenting with atrial fibrillation, severe atrioventricular regurgitation, severely dilated right heart with reduced function, and moderate pulmonary hypertension (PH), which was further complicated by congestive liver injury with ascites and pancytopenia. Thyroid work-up revealed suppressed TSH, elevated free T4 and T3 along with elevated anti-thyroglobulin antibodies, thyroid peroxidase antibodies, and thyroid-stimulating immunoglobulin, suggesting Graves’ thyrotoxicosis. Ultrasound of the abdomen was suggestive of liver cirrhosis and ascites, which was thought to be cardiac cirrhosis, after multiple negative work-ups for alternate causes of cirrhosis. Ascitic fluid analysis revealed portal hypertension as the cause. The patient was restarted on antithyroid medication with gradual improvement of thyroid function and in clinical and echocardiogram findings. In contrast to primary PH that carries a poor prognosis and has limited treatment options, PH due to Graves’ disease carries a good prognosis with prior reports of resolution after appropriate treatment, emphasizing the importance of early recognition. Also, unlike cirrhosis caused by alcohol or viral hepatitis, the effect of cardiac cirrhosis on overall prognosis has not been clearly established. |
| format | Article |
| id | doaj-art-abf77b78a1134ce6b04149e2794bf0c2 |
| institution | Kabale University |
| issn | 2090-6404 2090-6412 |
| language | English |
| publishDate | 2018-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Cardiology |
| spelling | doaj-art-abf77b78a1134ce6b04149e2794bf0c22025-02-03T06:13:06ZengWileyCase Reports in Cardiology2090-64042090-64122018-01-01201810.1155/2018/38613403861340Hyperthyroidism with Biventricular Heart Failure and Cirrhotic Transformation of the LiverRashmi Dhital0Shivani Vyas1Priyadarshani Sharma2Theresa Lynn3Oreoluwa Oladiran4Sijan Basnet5Reading Hospital, Tower Health System, West Reading, PA, USAReading Hospital, Tower Health System, West Reading, PA, USAReading Hospital, Tower Health System, West Reading, PA, USAReading Hospital, Tower Health System, West Reading, PA, USAReading Hospital, Tower Health System, West Reading, PA, USAReading Hospital, Tower Health System, West Reading, PA, USACardiovascular symptoms remain the most common presenting features and leading causes of death in hyperthyroidism. We report a young female with reported thyroid disease and medication noncompliance presenting with atrial fibrillation, severe atrioventricular regurgitation, severely dilated right heart with reduced function, and moderate pulmonary hypertension (PH), which was further complicated by congestive liver injury with ascites and pancytopenia. Thyroid work-up revealed suppressed TSH, elevated free T4 and T3 along with elevated anti-thyroglobulin antibodies, thyroid peroxidase antibodies, and thyroid-stimulating immunoglobulin, suggesting Graves’ thyrotoxicosis. Ultrasound of the abdomen was suggestive of liver cirrhosis and ascites, which was thought to be cardiac cirrhosis, after multiple negative work-ups for alternate causes of cirrhosis. Ascitic fluid analysis revealed portal hypertension as the cause. The patient was restarted on antithyroid medication with gradual improvement of thyroid function and in clinical and echocardiogram findings. In contrast to primary PH that carries a poor prognosis and has limited treatment options, PH due to Graves’ disease carries a good prognosis with prior reports of resolution after appropriate treatment, emphasizing the importance of early recognition. Also, unlike cirrhosis caused by alcohol or viral hepatitis, the effect of cardiac cirrhosis on overall prognosis has not been clearly established.http://dx.doi.org/10.1155/2018/3861340 |
| spellingShingle | Rashmi Dhital Shivani Vyas Priyadarshani Sharma Theresa Lynn Oreoluwa Oladiran Sijan Basnet Hyperthyroidism with Biventricular Heart Failure and Cirrhotic Transformation of the Liver Case Reports in Cardiology |
| title | Hyperthyroidism with Biventricular Heart Failure and Cirrhotic Transformation of the Liver |
| title_full | Hyperthyroidism with Biventricular Heart Failure and Cirrhotic Transformation of the Liver |
| title_fullStr | Hyperthyroidism with Biventricular Heart Failure and Cirrhotic Transformation of the Liver |
| title_full_unstemmed | Hyperthyroidism with Biventricular Heart Failure and Cirrhotic Transformation of the Liver |
| title_short | Hyperthyroidism with Biventricular Heart Failure and Cirrhotic Transformation of the Liver |
| title_sort | hyperthyroidism with biventricular heart failure and cirrhotic transformation of the liver |
| url | http://dx.doi.org/10.1155/2018/3861340 |
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