Hemodynamic variation is a dominant contributing factor of Graves' hyperthyroidism complication: Heart failure and fatal liver dysfunction, a case report and analysis

Abstract

Tachycardia and atrial fibrillation, early symptoms of hyperthyroidism indicate significant hemodynamic variation in cardiovascular system, if left untreated and further deterioration in hemodynamics can result in chronic heart failure and liver dysfunction even a fatal event. We describe a female patient of Graves' hyperthyroidism to present the continuum of the pathophysiology development of the disease, to highlight the hemodynamic variation is a dominant contributing factor of Graves' hyperthyroidism complication, we wish to emphasize cardiac manifestations in the setting of thyrotoxicosis should be treated promptly and aggressively.

Keywords: Graves' hyperthyroidism; atrial fibrillation; fatal liver dysfunction; heart failure; hemodynamic variation; tachycardia.

FIGURE 1

ECG and chest radiography on admission. (A) ECG showing atrial fibrillation and a heart rate of 80 beats/min (treated with metoprolol, 25 mg 2/day). (B) Chest radiography showing right pleural effusion and pulmonary congestion, the cardiothoracic ratio was 72%

FIGURE 2

Transthoracic echocardiogram reported (A) bilateral atrial and right ventricle enlargement with an left ventricular ejection fraction of 60%, (B） severe mitral and tricuspid regurgitation with elevated pulmonary artery pressure. CO, cardiac output; LA, left atrium; LV, left ventricle; LVDd, left ventricular end‐diastolic dimension; LVEF, left ventricular ejection fraction; PAP, pulmonary arterial pressure; RA, right atrium; RV, right ventricle; RVDd, right ventricular end‐diastolic dimension; SV, stroke volume

FIGURE 3

Serial levels of biochemical parameters during hospitalization. ALT, alanine aminotransferase; DBil, direct bilirubin; FT3, free triiodothyronine; FT4, free thyroxine; PTA, prothrombin activity; TBIL, total bilirubin