Thyrotoxic Pericardial Effusion Complicating Graves’ Disease in Pregnancy

Authors

  • Marc Gregory Yu Department of Medicine, University of the Philippines-Philippine General Hospital Manila
  • Hannah Urbanozo Department of Medicine, University of the Philippines-Philippine General Hospital Manila
  • Marcelyn Fusilero Department of Medicine, University of the Philippines-Philippine General Hospital Manila

Abstract

Pericardial effusion is a rare complication of Graves’ disease. A pregnant Filipino woman with diffuse goiter and hyperthyroid symptoms was initially treated as a case of Graves’ disease. She was readmitted for exertional dyspnea, orthopnea, and bipedal edema; an echocardiogram revealed a massive pericardial effusion. Workup for other causes of the effusion was unremarkable. The pericardial effusion resolved after pericardiostomy and anti-thyroid medications. This highlights the clinician’s role in determining the association between the two disease entities.

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References

Melmed S, Polonsky K, Larsen P, Kronenberg H, editors. Williams Textbook of Endocrinology, 12th edition. Philadelphia: Elsevier Saunders; 2011.

Baskin JH, Cobin RH, Duick DS, Gharib H, Guttler RB, Kaplan MM, et al. American Association of Clinical Endocrinologists Medical Guidelines for Clinical Practice for the Evaluation and Treatment of Hyperthyroidism and Hypothyroidism. Endocrine Practice. 2002 Dec; 8(6): 457-469.

Klein I, Ojamaa K. Thyroid hormone and the cardiovascular system. N Engl J Med. 2001; 344:501–509. http://dx.doi.org/10.1056/NEJM200102153440707.

Kahaly G, Dillmann W. Thyroid Hormone Action in the Heart. Endocrine Reviews. 2005; 26(5):704–728. http://dx.doi.org/10.1210/er.2003-0033.

Sampana A, Jasul G. High Grade AV Block Complicating Hyperthyroidism: A Case Report. Phil J Int Med. 2010 Jul-Sep; 48(2):38-40.

Umpierrez GE, Challapalli S, Patterson C. Congestive heart failure due to reversible cardiomyopathy in patients with hyperthyroidism. Am J of Med Sc. 1995; 310(3):99-102.

Ebisawa K, Ikeda U, Murata M, Sekiguchi H, Nagai R, Yazaki Y et al. Irreversible cardiomyopathy due to thyrotoxicosis. Cardiology. 1994; 84:274–7.

Jameson JL, Weetman AP. Disorders of the Thyroid Gland. In: Braunwald E, Fauci AS, Kasper D, Hauser HL, Longo D, Jameson JL, editors. Harrison’s Principles of Internal Medicine, 15th edition. New York: McGraw-Hill; 2001.

Spodick DH. Pericardial Diseases. In: Braunwald E, Zippes DP, Libby P, editors. Heart Disease, 6th edition. Philadelphia: WB Saunders; 2001.

Ovadia, S, Lysy y L, Zubkov T. Pericardial effusion as an expression of thyrotoxicosis. Tex Heart Inst J. 2007; 34(1):88-90.

Teague E, O’Brien C, Campbell N. Pericardial effusion and tamponade complicating treated Graves’ thyrotoxicosis. Ulster Med J. 2009; 78(1) 56-58.

Nakata A, Komiya R, Ieki Y, Yoshizawa H, Hirota S, Takazakura E. A patient with Graves’ disease accompanied by bloody pericardial effusion. Internal Medicine. 2005; 44(10):1064-1068.

Clarke NRA, Banning AP, Gwilt DJ, Scott AR. Pericardial disease associated with Graves’ thyrotoxicosis. QJM: An International Journal of Medicine. 2002; 95:188-189.

Khalid Y, Sulaiman R, Zahir R, Baskar V, and Buch HN. An unusual complication in a patient with Graves’ disease. New Zealand Med J. 2011; 124 (1341).

Levy PY, Corey R, Berger P, Habib G, Bonnet JL, Levy S, et al. Etiologic diagnosis of 204 pericardial effusions. Medicine (Baltimore). 2003; 82(6): 385-91.

Imazio M. Pericardial involvement in systemic inflammatory diseases. Heart. 2011; 97(22):1882-1892. http://dx.doi.org/10.1136/heartjnl-2011-300054.

Tumabiene KD, Chiong, L, Macapugay, L. Clinical Profile and Outcomes of Adult Patients with Echocardiographic Evidence of Cardiac Tamponade at the Philippine General Hospital: A Five-Year Study (The CAPTIVE-HEART Study). Unpublished.

Abduuabbar HS, Marzouki KM, Zawawi TH, Khan AS. Pericardial effusion in normal pregnant women. Acta Obstet Gynecol Scan. 1991; 70(4-5):291-294. http://dx.doi.org/10.3109/00016349109007874.

Nakamori Y, Tominaga T, Inoue Y, Shinohara K. Propylthiouracil (PTU)-induced vasculitis associated with antineutrophil antibody against myeloperoxidase (MPO-ANCA). Intern Med. 2003; 42(6):529-33.

Nowak M, Madrzak D, Kuźniar J, Grzywa M. Reversible thyrotoxic cardiomyopathy - report of three cases. Pol Arch Med Wewn. 2002 Oct; 108(4):979-82.

Roffi M, Cattaneo F, Topol E. Thyrotoxicosis and the cardiovascular system: subtle but serious effects. Cleveland Clinic J of Med. 2003; 70:57-63.

Parving HH, Hansen JM, Nielsen SL, Rossing N, Munck O, Lassen NA. Mechanisms of Edema Formation in Myxedema — Increased Protein Extravasation and Relatively Slow Lymphatic Drainage. N Engl J Med. 1979; 301(9):460–465. http://dx.doi.org/10.1056/NEJM197908303010902.

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Published

2015-07-31

How to Cite

Yu, M. G., Urbanozo, H., & Fusilero, M. (2015). Thyrotoxic Pericardial Effusion Complicating Graves’ Disease in Pregnancy. Journal of the ASEAN Federation of Endocrine Societies, 30(1), 44. Retrieved from https://www.asean-endocrinejournal.org/index.php/JAFES/article/view/177

Issue

Vol. 30 No. 1 (2015): May Issue

Section

Case Reports

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