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A case of pulmonary arterial hypertension associated with hyperthyroidism, persistent after euthyroidism was obtained.

Hwang JY, Bae SH, Lee JM, Kim DG, Ahn JH, Kim MS, Kim YD, Baek HG, Cho YR, Park TH - Korean Circ J (2010)

Bottom Line: Cardiovascular manifestations in hyperthyroidism occur frequently with various phenotypes.In previously reported cases, the hemodynamic and symptomatic recovery of pulmonary arterial hypertension is usually concomitant with achievement of euthyroidism.We report a patient who had pulmonary arterial hypertension associated with Graves' disease, which persisted after euthyroidism was obtained.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea.

ABSTRACT
Cardiovascular manifestations in hyperthyroidism occur frequently with various phenotypes. An association between hyperthyroidism and pulmonary arterial hypertension has been reported. In previously reported cases, the hemodynamic and symptomatic recovery of pulmonary arterial hypertension is usually concomitant with achievement of euthyroidism. We report a patient who had pulmonary arterial hypertension associated with Graves' disease, which persisted after euthyroidism was obtained.

No MeSH data available.


Related in: MedlinePlus

Chest radiograph on admission shows mild cardiomegaly with prominent pulmonary conus.
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Figure 1: Chest radiograph on admission shows mild cardiomegaly with prominent pulmonary conus.

Mentions: A 48-year-old woman presented at our institution on June 10, 2009 with a 4-week history of dyspnea on exertion, fatigue, hot flushes, palpitations, generalized edema, and weight gain. She had a history of hyperthyroidism (3 years ago), but had not pursued follow-up. She denied any prior history of effort-induced dyspnea or chest discomfort before the diagnosis of thyroid disease was made. On physical examination, raised jugular venous pressure, a slightly enlarged thyroid gland, and marked lower limb edema were observed. There was no audible heart murmur. Chest radiography showed mild cardiomegaly with prominent pulmonary conus (Fig. 1). Electrocardiogram showed sinus rhythm at 100 beats per minute. She underwent transthoracic echocardiogram, which revealed a dilated right ventricle, reduced right ventricular systolic function, and an elevated systolic pulmonary arterial pressure over 57 mmHg. The left ventricular chamber size was normal with an ejection fraction of 65%, and the valves appeared normal. Transesophageal echocardiogram revealed no intracardiac shunts. Computed tomographic scanning of the chest did not reveal any evidence of parenchymal lung disease or pulmonary thromboembolism. A ventilation-perfusion scan of the chest showed that pulmonary embolism was unlikely. Pulmonary function test (FEV1/FVC=87.2%) revealed no evidence of chronic obstructive lung disease. Thyroid function tests showed a decreased serum thyroid-stimulating hormone (TSH) level of 0.06 uIU/mL (normal, 0-4 uIU/mL), an increased serum free thyroxin (FT4) level of 2.91 ng/dL (normal, 0.8-2.2 ng/dL). Anti-thyroperoxidase antibody was 404.97 IU/mL (nonreactive, 0-50 IU/mL) and TSH-receptor antibody was >404 U/I (normal, 0-14 U/l). Thyroid scan showed diffuse increased uptake suggestive of Graves' disease. A set of anti-nuclear antibody test which includes 13 antibodies against various component of nucleus was negative. We started treating the patient with methimazole (30 mg/day) and furosemide.


A case of pulmonary arterial hypertension associated with hyperthyroidism, persistent after euthyroidism was obtained.

Hwang JY, Bae SH, Lee JM, Kim DG, Ahn JH, Kim MS, Kim YD, Baek HG, Cho YR, Park TH - Korean Circ J (2010)

Chest radiograph on admission shows mild cardiomegaly with prominent pulmonary conus.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3008831&req=5

Figure 1: Chest radiograph on admission shows mild cardiomegaly with prominent pulmonary conus.
Mentions: A 48-year-old woman presented at our institution on June 10, 2009 with a 4-week history of dyspnea on exertion, fatigue, hot flushes, palpitations, generalized edema, and weight gain. She had a history of hyperthyroidism (3 years ago), but had not pursued follow-up. She denied any prior history of effort-induced dyspnea or chest discomfort before the diagnosis of thyroid disease was made. On physical examination, raised jugular venous pressure, a slightly enlarged thyroid gland, and marked lower limb edema were observed. There was no audible heart murmur. Chest radiography showed mild cardiomegaly with prominent pulmonary conus (Fig. 1). Electrocardiogram showed sinus rhythm at 100 beats per minute. She underwent transthoracic echocardiogram, which revealed a dilated right ventricle, reduced right ventricular systolic function, and an elevated systolic pulmonary arterial pressure over 57 mmHg. The left ventricular chamber size was normal with an ejection fraction of 65%, and the valves appeared normal. Transesophageal echocardiogram revealed no intracardiac shunts. Computed tomographic scanning of the chest did not reveal any evidence of parenchymal lung disease or pulmonary thromboembolism. A ventilation-perfusion scan of the chest showed that pulmonary embolism was unlikely. Pulmonary function test (FEV1/FVC=87.2%) revealed no evidence of chronic obstructive lung disease. Thyroid function tests showed a decreased serum thyroid-stimulating hormone (TSH) level of 0.06 uIU/mL (normal, 0-4 uIU/mL), an increased serum free thyroxin (FT4) level of 2.91 ng/dL (normal, 0.8-2.2 ng/dL). Anti-thyroperoxidase antibody was 404.97 IU/mL (nonreactive, 0-50 IU/mL) and TSH-receptor antibody was >404 U/I (normal, 0-14 U/l). Thyroid scan showed diffuse increased uptake suggestive of Graves' disease. A set of anti-nuclear antibody test which includes 13 antibodies against various component of nucleus was negative. We started treating the patient with methimazole (30 mg/day) and furosemide.

Bottom Line: Cardiovascular manifestations in hyperthyroidism occur frequently with various phenotypes.In previously reported cases, the hemodynamic and symptomatic recovery of pulmonary arterial hypertension is usually concomitant with achievement of euthyroidism.We report a patient who had pulmonary arterial hypertension associated with Graves' disease, which persisted after euthyroidism was obtained.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea.

ABSTRACT
Cardiovascular manifestations in hyperthyroidism occur frequently with various phenotypes. An association between hyperthyroidism and pulmonary arterial hypertension has been reported. In previously reported cases, the hemodynamic and symptomatic recovery of pulmonary arterial hypertension is usually concomitant with achievement of euthyroidism. We report a patient who had pulmonary arterial hypertension associated with Graves' disease, which persisted after euthyroidism was obtained.

No MeSH data available.


Related in: MedlinePlus