Right Heart Failure and Hyperthyroidism: A Neglected Association

2020 ARC Journal of Cardiology  
Hyperthyroidism is a hyperkinetic syndrome related to an excess of circulating thyroid hormones. We report the case of a patient with Grave's disease who was admitted for right heart failure due to reversible thyrotoxic tricuspid regurgitation. Case report: A 65-year-old patient, without medical history. He was admitted with dyspnea and bilateral leg edema. The examination revealed a tachycardia with signs of right heart failure. The electrocardiogram showed atrial fibrillation with an average
more » ... entricular rate of 112 beats per minute and low voltage in the frontal leads.Transthoracic echocardiography showed a very dilated right ventricle with a paradoxical septum motion. The tricuspid valve presents a lack of coaptation affecting the three leaflets which is responsible for massive tricuspid regurgitation. The inferior vena cava was dilated without collapse. Biological testing showed a very low thyroid-stimulating hormone (<0.003) and a high T4 and T3. Immunological testing confirmed Grave's disease. Our treatment approach was built on diuretics and treating hyperthyroidism with antithyroid drugs. We eliminated every etiology that would justify a functional tricuspid regurgitation. The evolution was marked by a regression of the congestive signs, a return to sinus rhythm after 40 days of treatment and a regression of both the tricuspid regurgitation and the dilation of the right ventricle nine months after antithyroid therapy. Conclusion: This is a case of cardiothyreosis complicated by right heart failure caused by severe tricuspid regurgitation which is reversible under antithyroid therapy. We underline the advisability of carrying out a systematic thyroid assessment when presented with unexplained right heart failure.
doi:10.20431/2455-5991.0601004 fatcat:dqkfidvadzetphicl2gqoqoxa4