Graves’ disease presenting as bi - ventricular heart failure with severe pulmonary hypertension and pre-eclampsia in pregnancy – a case report and review of the literature

BMC Research Notes

Humayara Tabassum²  Mohammad Monjurul Kader Chowdhury²  Md Shariful Alam²  Mohammed Abaye Deen Saleh²  Md Imam Hosen²  Shamima Kawser¹  Fathima Aaysha Cader²  Mohammad Shahidul Islam²  Abdul Wadud Chowdhury²  Khandker Mohammad Nurus Sabah² 

[1] Department of Microbiology, Dr. Sirajul Islam Medical College, Dhaka, Bangladesh;Department of Cardiology, Dhaka Medical College Hospital, Dhaka, Bangladesh

关键词: Pregnancy;    Pre-eclampsia;    Pulmonary Hypertension;    Bi- Ventricular Heart Failure;    Hypertension;    Graves’ disease;   

Others  :  1123230
DOI  :  10.1186/1756-0500-7-814

 received in 2014-05-18, accepted in 2014-11-11,  发布年份 2014

【 摘 要 】

Background

Graves’ disease, a well-known cause of hyperthyroidism, is an autoimmune disease with multi-system involvement. More prevalent among young women, it appears as an uncommon cardiovascular complication during pregnancy, posing a diagnostic challenge, largely owing to difficulty in detecting the complication, as a result of a low index of suspicion of Graves’ disease presenting during pregnancy. Globally, cardiovascular disease is an important factor for pregnancy-related morbidity and mortality. Here, we report a case of Graves’ disease detected for the first time in pregnancy, in a patient presenting with bi- ventricular heart failure, severe pulmonary hypertension and pre- eclampsia. Emphasis is placed on the spectrum of clinical presentations of Graves’ disease, and the importance of considering this thyroid disorder as a possible aetiological factor for such a presentation in pregnancy.

Case presentation

A 30-year-old Bangladeshi-Bengali woman, in her 28th week of pregnancy presented with severe systemic hypertension, bi-ventricular heart failure and severe pulmonary hypertension with a moderately enlarged thyroid gland. She improved following the administration of high dose intravenous diuretics, and delivered a premature female baby of low birth weight per vaginally, twenty four hours later. Pre-eclampsia was diagnosed on the basis of hypertension first detected in the third trimester, 3+ oedema and mild proteinuria. Electrocardiography revealed sinus tachycardia with incomplete right bundle branch block and echocardiography showed severe pulmonary hypertension with an estimated pulmonary arterial systolic pressure of 73 mm Hg, septal and anterior wall hypokinesia with an ejection fraction of 51%, grade I mitral and tricuspid regurgitation. Thyroid function tests revealed a biochemically hyperthyroid state and positive anti- thyroid peroxidase antibodies was found. ^99mTechnetium pertechnetate thyroid scans demonstrated diffuse toxic goiter as evidenced by an enlarged thyroid gland with intense radiotracer concentration all over the gland. The clinical and biochemical findings confirmed the diagnosis of Graves’ disease.

Conclusions

Graves’ disease is an uncommon cause of bi-ventricular heart failure and severe pulmonary hypertension in pregnancy, and a high index of clinical suspicion is paramount to its effective diagnosis and treatment.

【 授权许可】

   
2014 Sabah et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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