scholarly journals Double trouble – thyro-pericarditis: rare presentation of Graves’ disease as pericarditis—a case report

2020 ◽  
Author(s):  
Mohsin Gondal ◽  
Ali Hussain ◽  
Hira Yousuf ◽  
Zahra Haider
Keyword(s):  
Clinical Examination ◽  
Systolic Function ◽  
Beta Blockers ◽  
Case Reports ◽  
Left Ventricular ◽  
Graves Disease ◽  
Thyroid Function Tests ◽  
Free T4 ◽  
Rare Presentation ◽  
Acute Pericarditis

Abstract Background Acute pericarditis is frequently encountered in clinical practice; however, pericarditis as the first presentation of Graves' disease is rare and mainly limited to case reports in the literature. We hereby report a case in which a young patient presented with pericarditis as the first manifestation of Graves’ disease. Case summary A 24-year-old male was admitted to hospital with presenting complaint of left-sided chest pain, gradual in onset, 6/10 in intensity, sharp in character, increased by deep breathing and improved by leaning forward. Patient also gave a history of insomnia, unintentional weight loss despite a good appetite, heat intolerance, and anxiety. On clinical examination, the patient had features of thyrotoxicosis, i.e., tachycardia, high volume pulse, and sweaty palms with fine tremors. There was no associated pericardial rub. Neck examination shows diffuse, non-tender goitre. Electrocardiogram findings were consistent with acute pericarditis. His thyroid function tests demonstrated hyperthyroidism and anti-thyroglobulin antibodies were also significantly elevated. Echocardiogram showed preserved left ventricular systolic function and a small global pericardial effusion without any signs of tamponade. He was diagnosed with Graves’ disease revealing itself as pericarditis and was started on ibuprofen, beta-blockers, and carbimazole. Patient had marked clinical and biochemical improvement on 3 monthly follow-ups. Discussion Thyro-pericarditis is a rare entity, and limited literature is available regarding this combination. The exact aetiology of Graves associated pericarditis is unknown. There is a possibility of interaction of autoantibodies with receptors on pericardium. Diagnosis is based on a detailed history, clinical examination, supplemented by relevant investigations (elevated free T4 and thyroid receptor antibodies, suppressed thyroid stimulating hormone (TSH) and Imaging via ultrasound). Mainstay of treatment includes non-steroidal anti-inflammatory drugs, beta-blockers, and anti-thyroidal medications.

scholarly journals SUN-LB88 Thyrotoxic Periodic Paralysis in Hispanic Patients

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Tahira Sarwar ◽  
Jose Martinez ◽  
Johnathan Kirupakaran ◽  
Giovanna Rodriguez ◽  
Gül Bahtiyar
Keyword(s):  
Early Recognition ◽  
Case Reports ◽  
Laboratory Data ◽  
Periodic Paralysis ◽  
Graves Disease ◽  
Free T4 ◽  
Rare Presentation ◽  
Thyrotoxic Periodic Paralysis ◽  
Lower Extremity Weakness ◽  
Abnormal Gait

Abstract BACKGROUND: Thyrotoxic periodic paralysis (TPP) presents as acute intermittent attacks of weakness related to hypokalemia, commonly reported in Asians and rare in Hispanics(1). Patients with TPP will have triiodothyronine (T3) triggered increased Na+/K+ ATPase pump activity and transcription of the KCNJ18 gene that encodes for the Kir2.6 channel(2). This permits insulin, catecholamines, stress and alcohol(3) to increase cellular intake of potassium, which causes depolarization and leads to weakness and paralysis. We report a case of TPP in a young Hispanic man who presented with lower extremity weakness and falls. CASE PRESENTATION: A 34-year-old Hispanic man with Graves’ disease, non-adherent to medications presented with generalized weakness, more pronounced in legs, and recurrent falls. Physical examination was unremarkable except for mild enlargement of thyroid gland and abnormal gait due to weakness. Laboratory data showed hypokalemia of 1.8 mmol/L (3.7-5.1 mmol/L) and a TSH level of <0.004 mIU/L (0.34-5.6 mIU/L). Free T4 3.74 ng/dL (0.6-1.6 ng/dL), free T3 597 pg/dL (230-420 Pg/dL), thyroid stimulating Ig 148 (<130). Electrocardiogram did not show U waves. Radio iodine 123 scan of thyroid revealed diffusely increased 24-hour radioactive uptake of 66.5% (10-30%). The patient was diagnosed with TPP and supplemented with three doses of potassium 40 mEq IV infusion. Methimazole and metoprolol were started. He made a good clinical recovery within days. After discharge, he was treated with I-131 (13 mci) and developed postablative hypothyroidism on long term. He was euthyroid on levothyroxine. He did not have any recurrence of weakness at 7-year follow-up. CONCLUSION: TPP is uncommonly seen in Hispanics patients as opposed to Asians(3). Physicians should consider TPP as part of the differential diagnosis in young hyperthyroid Hispanic men presenting with weakness or paralysis, as early recognition and treatment can reduce recovery time and potentially prevent tachyarrhythmia or death. REFERENCES: 1. Matta A, Koppala J, Gossman W. Thyrotoxic hypokalaemic periodic paralysis: a rare presentation of Graves’ disease in a Hispanic patient. BMJ Case Rep. 2014;2014. 2. Ryan DP, Ptacek LJ. Mutations in Potassium Channel Kir2.6 Cause Susceptibility to Thyrotoxic Hypokalemic Periodic Paralysis. Cell, 140(1), pp.88-98. 3. Amblee, A. and Gulati, S. (2016). Thyrotoxic Periodic Paralysis: Eight Cases in Males of Hispanic Origin from a Single Hospital. AACE Clinical Case Reports, 2(1), pp.e58-e64.

ID: 17: GRAVES DISEASE INDUCED DILATED CARDIOMYOPATHY

2016 ◽  
Vol 64 (4) ◽  
pp. 924.2-925
Author(s):  
H Alkhawam ◽  
N Vyas ◽  
R Sogomonian ◽  
A Al-khazraji ◽  
M Kabach
Keyword(s):  
Atrial Fibrillation ◽  
Dilated Cardiomyopathy ◽  
Systolic Function ◽  
Lower Extremities ◽  
Left Ventricular ◽  
Exercise Intolerance ◽  
Graves Disease ◽  
Metabolic Demand ◽  
Free T4 ◽  
Severe Left Ventricular Dysfunction

IntroductionGraves' thyrotoxicosis has many cardiovascular complications; however, the most cardiac complication is atrial fibrillation but rarely causes heart failure. Less than 1% develops dilated cardiomyopathy with impaired left ventricular systolic function. In this case report we describe a case of Graves' hyperthyroidism-induced reversible cardiomyopathy.Case presentation45 year old female with a history of previously treated Graves' disease who presented to hospital for altered mental status and severe hypoglycemia. The hospital course complicated by Atrial fibrillation with RVR. Patient states that recently started feeling fatigue, orthopnea, decrease exercise intolerance, lower extremities edema and distended abdomen. In emergency department, patient found to have hypotension and tachycardic. She was given IV fluids but her blood pressure didn't respond. Patient was started on Levophed for hypotension. Physical examination demonstrated impressive proptosis, positive jugular venous distension, irregular irregularity of her plus and +2 lower extremities edema .Patient found to have Graves storm (TSH: 0.07 uIU/ml, Free T4: 1.89 ng/dL, T3: 36.6 ng/dL, cortisol level: 59.36 Ug/dL). She was started on methimazole, steroids and lugols iodine drops. Hypoglycemia that she had most likely was related to lack of glycogen stores and increased metabolic demand with graces. After the patient stabilized, echocardiogram obtained which showed severe left ventricular dysfunction (LVEF 30%), bi-atrial dilatation, LV dilated, moderate MR and TR. So, patient was transferred to CCU for acute dilated cardiomyopathy secondary to graves storm. She was started on Lasix 40 mg IV then switched to 20 mg PO twice a day, Metoprolol 25 mg twice a day and Digoxin 0.125 mg daily and Apixaban 5 mg twice daily. Ophthalmology consulted for proptosis who recommended artificial tears, ocular lubricant and decompression.Abstract ID: 17 Figure 1

scholarly journals Pericardial effusion and cardiac tamponade requiring pericardial window in an otherwise healthy 30-year-old patient with COVID-19: a case report

2020 ◽  
Vol 14 (1) ◽  
Author(s):  
Christina Walker ◽  
Vincent Peyko ◽  
Charles Farrell ◽  
Jeanine Awad-Spirtos ◽  
Matthew Adamo ◽  
...  
Keyword(s):  
Case Report ◽  
Pericardial Effusion ◽  
Cardiac Tamponade ◽  
Case Reports ◽  
Healthy Woman ◽  
Signs And Symptoms ◽  
Rare Presentation ◽  
Pericardial Window ◽  
Acute Pericarditis ◽  
Novel Coronavirus

Abstract Background This case report demonstrates pericardial effusion, acute pericarditis, and cardiac tamponade in an otherwise healthy woman who had a positive test result for coronavirus disease 2019. Few case reports have been documented on patients with this presentation, and it is important to share novel presentations of the disease as they are discovered. Case presentation A Caucasian patient with coronavirus disease 2019 returned to the emergency department of our hospital 2 days after her initial visit with worsening chest pain and shortness of breath. Imaging revealed new pericardial effusion since the previous visit. The patient became hypotensive, was taken for pericardial window for cardiac tamponade with a drain placed, and was treated for acute pericarditis. Conclusion Much is still unknown about the implications of coronavirus disease 2019. With the novel coronavirus disease 2019 pandemic, research is still in process, and we are slowly learning about new signs and symptoms of the disease. This case report documents a lesser-known presentation of a patient with coronavirus disease 2019 and will help to further understanding of a rare presentation.

scholarly journals Determinants of Extraocular Muscle Volume in Patients with Graves' Disease

2012 ◽  
Vol 2012 ◽  
pp. 1-4 ◽  
Author(s):  
Samer El-Kaissi ◽  
Jack R. Wall
Keyword(s):  
Extraocular Muscle ◽  
Tsh Receptor ◽  
Graves Disease ◽  
Thyroid Function Tests ◽  
Thyroid Scintigraphy ◽  
Free T4 ◽  
Receptor Antibody ◽  
Tsh Receptor Antibody ◽  
Antibody Positivity ◽  
Serum Tsh

Background. To examine factors contributing to extraocular muscle (EOM) volume enlargement in patients with Graves’ hyperthyroidism.Methods. EOM volumes were measured with orbital magnetic resonance imaging (MRI) in 39 patients with recently diagnosed Graves’ disease, and compared to EOM volumes of 13 normal volunteers. Thyroid function tests, uptake on thyroid scintigraphy, anti-TSH-receptor antibody positivity and other parameters were then evaluated in patients with EOM enlargement.Results. 31/39 patients had one or more enlarged EOM, of whom only 2 patients had clinical EOM dysfunction. Compared to Graves’ disease patients with normal EOM volumes, those with EOM enlargement had significantly higher mean serum TSH (0.020±0.005versus0.007±0.002mIU/L;Pvalue 0.012), free-T4 (52.9±3.3versus41.2±1.7 pmol/L;Pvalue 0.003) and technetium uptake on thyroid scintigraphy (13.51±1.7%versus8.55±1.6%;Pvalue 0.045). There were no differences between the 2 groups in anti-TSH-receptor antibody positivity, the proportion of males, tobacco smokers, or those with active ophthalmopathy.Conclusions. Patients with recently diagnosed Graves’ disease and EOM volume enlargement have higher serum TSH and more severe hyperthyroidism than patients with normal EOM volumes, with no difference in anti-TSH-receptor antibody positivity between the two groups.

Abstract P024: Pharmacological Treatment of Hypertension and Lv Dysfunction Predictors in ESRD Patients With AV Fistula

Hypertension ◽  
2015 ◽  
Vol 66 (suppl_1) ◽  
Author(s):  
Sayed Tariq ◽  
James Anderson ◽  
Rohit Dhingra ◽  
Mikhail Torosoff
Keyword(s):  
Systolic Function ◽  
Beta Blockers ◽  
Systolic Dysfunction ◽  
Left Ventricular ◽  
Channel Blockers ◽  
Ca Channel ◽  
Av Fistula ◽  
Fistula Surgery ◽  
Lv Dysfunction ◽  
Ca Channel Blockers

Background: Effects of anti-hypertensive medications on left ventricular dimensions and systolic function in patients with arterio-venous (AV) fistulas have not been well investigated. Material and Methods: Medical charts and echocardiograms of 346 patients with AV fistula were reviewed. Of 346, 149 patients had TTE prior to the AV fistula surgery, 197 had TTE after the AV fistula surgery, and 76 patients had TTE before and after the AV fistula surgery. Data on medication use was available in 314 patients. ANOVA, chi-square, and logistic regression tests were employed. Results: In patients scheduled for AV fistula placement, 20% (31/149) patients had systolic dysfunction and 15% (22/142) had increased LV end-diastolic dimensions (LVEDD). Moderate systolic LV dysfunction was observed in 6% (9/149) and additional 8% (12/149) had severe LV dysfunction. Increased LVEDD with some LV dysfunction was noted in 27% (38/142).Following the AV fistula placement, 18% (36/197) of patients had systolic dysfunction and 12% (22/187) had increased LV end-diastolic dimensions (LVEDD). Moderate or severe systolic LV dysfunction was observed in 6% (5/197). LV systolic dysfunction or dilatation was noted in 23% (43/187). Of 314 patients, 63% were on beta-blockers (BB), 25% were on ACE inhibitor or an ARB , 43% on calcium-channel blocker , and 15% on alpha-antagonist . BB, ACEi-ARB, or AA were not associated with increased LVEDD or systolic dysfunction before or after the AV fistula placement. Prior to AV fistula, CCB treatment was not related to LV dilatation (36% in each group, p=0.981) Post AV fistula, CCB treatment was associated with increased LV dimensions (71% vs. 46%, p=0.029) but not LV systolic dysfunction (49% in LV dysfunction vs. 38% in the rest, p=0.446) . This association persisted after adjustment for co-morbidities and demographic parameters. Conclusions: LV systolic dysfunction and/or dilatation are common in patients undergoing AV fistula surgery. Despite decreased use of Ca-channel blockers in patients with LV dysfunction prior to AV fistula, Ca-channel blockers are associated with increased LV dimensions post AV fistula, and probably should be avoided in this vulnerable patient population.

scholarly journals POST-CORONAVIRUS DISEASE 2019 DE QUERVAIN’S THYROIDITIS – A CASE REPORT AND LITERATURE REVIEW

2021 ◽  
pp. 4-6
Author(s):  
MOHAMAD SAFWAN ◽  
VIJAYAN KN ◽  
NAJEEB ◽  
JITHU TG
Keyword(s):  
Neck Pain ◽  
Beta Blockers ◽  
Thyroid Stimulating Hormone ◽  
Thyroid Function Tests ◽  
C Reactive Protein ◽  
Free T4 ◽  
Persistent Fever ◽  
Reactive Protein ◽  
Technetium Uptake

De Quervain’s thyroiditis, also known as subacute thyroiditis (SAT), is a self-limiting inflammatory thyroid disease typically occurring a few weeks after a respiratory viral infection. A 29-year-old female with no comorbidities presented with persistent fever, neck pain, and swelling of 10 days duration. She also had tremors, fatigue, and palpitation. A careful enquiry revealed that she had been diagnosed with coronavirus disease 2019 (COVID-19) infection 6 weeks ago and had recovered uneventfully with conservative management. Her laboratories showed leukocytosis, elevated erythrocyte sedimentation rate, and C-reactive protein. Thyroid function tests (TFTs) yielded low thyroid-stimulating hormone, and high T3 and free T4. Ultrasonography neck was suggestive of thyroiditis. Thyroid scintigraphy demonstrated very low technetium uptake which confirmed SAT. Her symptoms ameliorated with nonsteroidal anti-inflammatory drug and beta-blockers and her TFTs improved during follow-up. We report this as emerging sequelae of COVID-19 infection. A persistent fever and neck pain following recent COVID-19 infection should alert clinician toward the possibility of de Quervain’s thyroiditis following severe acute respiratory syndrome coronavirus 2.

307Clinical outcomes of pacing induced cardiomyopathy in patients with preserved left ventricular systolic function and atrioventricular block

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
O Dor ◽  
M Haim ◽  
O Barrett ◽  
V Novack ◽  
Y Konstantino
Keyword(s):  
Atrioventricular Block ◽  
Systolic Function ◽  
Beta Blockers ◽  
Left Ventricular Systolic Function ◽  
Left Ventricular ◽  
Rv Pacing ◽  
Baseline Characteristics ◽  
First Time ◽  
Normal Lvef

Abstract Funding Acknowledgements None Background Patients with preserved LVEF and atrioventricular block (AVB) who are anticipated for high-burden of right ventricular (RV) pacing possess a risk to develop pacing induced cardiomyopathy (PICM). Aims To evaluate the incidence and outcomes of RV-PICM in this patient"s population. Methods 1013 patients with AVB underwent first time pacemaker (PM) implantation between 2002 and 2016. A total of 203 patients with normal LVEF were included. Follow-up echocardiography was examined for a decrease in LVEF > 10%. Alternative causes for cardiomyopathy were excluded. Patient"s characteristics, mortality and hospitalizations for heart failure (HF) were compared between the PICM and non-PICM groups.  Results 51 patients (25%) developed PICM, with 22 patients (11%) showing LVEF < 40%. During mean follow-up of 49.2 months, the risk of HF hospitalization or all-cause mortality was significantly higher in the PICM group (35.3% vs. 19.1%, p = 0.009). LVEDD was independently associated with PICM (HR = 1.10, 95% CI: 1.03-1.17, p = 0.01) and CAD was nearly associated with PICM (HR = 2.19, 95% CI: 0.98-4.90, p = 0.06).  Conclusions The incidence of PICM in patients with normal LVEF and AVB is alarmingly high. PICM in patients with a previously normal LVEF is associated with unfavorable outcomes. Table 1 Characteristics Cohort without PICM (152) n (%) Cohort with PICM (51) n(%) p Age mean ± SD 74.6 ± 10.5 71 ± 13 0.04 Gender (male) 80 (52.6) 29 (56.9) 0.6 Pacing modeDDDVDDVVI 108 (71.1) 38 (25) 6 (3.9) 34 (66.7) 15 (29.4) 2(3.9) 0.83 Hypertension 112 (73.7) 36 (70.6) 0.67 PVD 16 (10.5) 5 (8.9) 0.88 CAD 36 (23.7) 19 (37.3) 0.01 CVA / TIA 17 (11.2) 7 (13.7) 0.63 Atrial fibrillation / flutter 18 (11.8) 9 (17.6) 0.29 COPD 15 (9.9) 2 (3.9) 0.25 Diabetes Mellitus 56 (36.8) 27 (52.9) 0.04 Chronic Kidney Disease 27 (17.9) 14 (27.5) 0.14 Statins 65 (43) 30(60) 0.04 ACE inhibitors / ARBs 52 (34.4) 18 (36) 0.84 Beta Blockers 42 (28) 10 (20) 0.26 LVEDD mm 45.13 ± 5.53 48.46 ± 5.97 <0.001 LVESD mm 25.68 ± 5.28 27.72 ± 4.67 0.02 Baseline characteristics Abstract Figure. HF and Mortality outcomes

scholarly journals Registry-based randomised clinical trial: efficient evaluation of generic pharmacotherapies in the contemporary era

Heart ◽  
2018 ◽  
Vol 104 (19) ◽  
pp. 1562-1567 ◽  
Author(s):  
Troels Yndigegn ◽  
Robin Hofmann ◽  
Tomas Jernberg ◽  
Chris P Gale
Keyword(s):  
Clinical Trial ◽  
Systolic Function ◽  
Beta Blockers ◽  
Left Ventricular Systolic Function ◽  
Randomised Clinical Trial ◽  
Left Ventricular ◽  
Data Sampling ◽  
Low Costs ◽  
Clinical Questions

Randomised clinical trials are the gold standard for testing the effectiveness of clinical interventions. However, increasing complexity and associated costs may limit their application in the investigation of key cardiovascular knowledge gaps such as the re-evaluation of generic pharmacotherapies. The registry-based randomised clinical trial (RRCT) leverages data sampling from nationwide quality registries to facilitate high participant inclusion rates at comparably low costs and, therefore, may offer a mechanism by which such clinical questions may be answered. To date, a number of studies have been conducted using such trial designs, but uncritical use of the RRCT design may lead to erroneous conclusions. The current review provides insights into the strengths and weaknesses of the RRCT, as well as provides an exploratory example of how a trial may be designed to test the long-term effectiveness of beta blockers in patients with myocardial infarction who have preserved left ventricular systolic function.

scholarly journals Ruptured Hydatid Cysts Resulted in Infectious Pericardial Effusion and Development of Cardiac Tamponade: A Rare Presentation

2021 ◽  
Vol In Press (In Press) ◽  
Author(s):  
Zahra Alizadeh sani ◽  
Nahid Azdaki ◽  
SeyedAli Moezi ◽  
Mohaddeseh Behjati ◽  
Roohallah Alizadehsani ◽  
...  
Keyword(s):  
Cardiac Tamponade ◽  
Spiral Ct ◽  
Cystic Mass ◽  
Left Ventricular ◽  
Hydatid Cysts ◽  
Rare Presentation ◽  
Acute Pericarditis ◽  
Surgical Specimen ◽  
Pericardial Space ◽  
Lethal Complications

Introduction: Cardiac Hydatidosis is a rare and ominous complication of hydatid disease. Cardiac echinococcosis may be asymptomatic for several years but could be discovered after the development of lethal complications. Case Presentation: A 31-year-old-male referred with possible diagnosis of acute pericarditis. Abdominal and pelvic spiral CT scan showed focal and heterogeneous increased thickness of lateral left ventricular (LV) wall with protrusion into LV and bulging into pericardial space without central enhancement. His condition deteriorated suddenly due to cardiac tamponade with round cystic lesions suspected to hydatid cyst. Cardiac magnetic resonance imaging showed some round particles within effusion suggestive of possible scolex around the LV. There was round, and inhomogeneous cystic mass originated from sub-epicardial layer of mid-lateral LV that protruded into pericardial space. Diagnosis of hydatic cyst was confirmed by surgical specimen. Conclusions: We suggest that patients with pericarditis should be probed with echocardiography for the presence of hydatid cysts.

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