Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2024 Jul 24;16(7):e65301.
doi: 10.7759/cureus.65301. eCollection 2024 Jul.

New-Onset Graves' Disease Presenting As Thyro-Pericarditis

Ji-Cheng Hsieh  1 , Spencer Weintraub  1 , Karim Diab  2 , Ally W Wang  3 , Robert Copeland-Halperin  2
Affiliations
Case Reports

New-Onset Graves' Disease Presenting As Thyro-Pericarditis

Ji-Cheng Hsieh et al. Cureus. .

Abstract

Acute perimyocarditis is commonly preceded by viral illness and presents with non-specific complaints that can be a manifestation of serious cardiac complications such as arrhythmias and heart failure. While pericarditis is a known complication of thyrotoxicosis, termed "thyrotoxic pericarditis," concomitant new-onset perimyocarditis and Graves' disease, termed "thyro-pericarditis," has been reported. We present a case of thyro-pericarditis as the initial presentation of undiagnosed and untreated Graves' disease co-occurring with recent Coxsackievirus A and B infection. A 27-year-old male with a family history of undifferentiated hyperthyroidism presented with acute pleuritic chest pain and shortness of breath. Laboratory testing showed elevated cardiac troponin I with ST elevations and PR depressions on initial ECG. Left heart catheterization was normal, but transthoracic echocardiogram showed right ventricular systolic dysfunction and enlargement. Cardiac MRI demonstrated diffuse pericardial enhancement suggesting pericarditis. Thyroid function testing and thyroid ultrasound suggested auto-immune thyrotoxicosis. Serology noted abnormal Coxsackievirus A and B IgG antibody titers, suggesting prior infection. The patient was treated with colchicine, ibuprofen, methimazole, and metoprolol, with resolution of symptoms. Thyro-pericarditis is a rare concomitant presentation of both Graves' disease and myopericarditis, and it remains unknown whether there is an increased risk of adverse cardiac outcomes.

Keywords: graves´disease; myopericarditis; pericarditis; thyro-pericarditis; thyrotoxic pericarditis; thyrotoxicosis.

PubMed Disclaimer

Conflict of interest statement

Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Diffuse ST elevations (red arrows) and PR depressions (blue arrows), with reciprocal ST depressions (black arrows) and PR elevations (white arrows) in aVR and V1 on initial ECG, suggestive of pericarditis.
Figure 2
Figure 2. Right anterior oblique cranial view during coronary angiography, demonstrating no stenoses or abnormalities of the left anterior descending (red arrow) and diagonal branch (blue arrow).
Figure 3
Figure 3. Right anterior oblique caudal view during coronary angiography, demonstrating no stenoses or abnormalities of the left circumflex (red arrow) and left marginal arteries (blue arrows).
Figure 4
Figure 4. Right coronary artery view during coronary angiography, demonstrating no stenoses or abnormalities of the right coronary artery (red arrow).
Figure 5
Figure 5. Axillary cardiac MRI view demonstrating diffuse pericardial enhancement (red arrow) consistent with a diagnosis of pericarditis.
Figure 6
Figure 6. Sagittal cardiac MRI view demonstrating diffuse pericardial enhancement (red arrow) consistent with a diagnosis of pericarditis.
Figure 7
Figure 7. Repeat ECG eight months after discharge showing resolution of ST elevations and PR depressions.
See this image and copyright information in PMC

References

    1. Myocarditis. Sagar S, Liu PP, Cooper LT Jr. Lancet. 2012;379:738–747. - PMC - PubMed
    1. Evaluation and treatment of pericarditis: a systematic review. Imazio M, Gaita F, LeWinter M. JAMA. 2015;314:1498–1506. - PubMed
    1. Recent advances in HIV-associated cardiovascular diseases in Africa. Syed FF, Sani MU. Heart. 2013;99:1146–1153. - PubMed
    1. Myopericarditis in a patient with hepatitis C and cryoglobulinemic renal disease. Ali MA, Kayani WZ, Linzie BM, Punjabi GV, Wetmore JB. Clin Case Rep. 2017;5:616–620. - PMC - PubMed
    1. The 2015 ESC Guidelines on the diagnosis and management of pericardial diseases. Adler Y, Charron P. Eur Heart J. 2015;36:2873–2874. - PubMed

Publication types

LinkOut - more resources