Endocrinol Metab.  2011 Sep;26(3):248-252. 10.3803/EnM.2011.26.3.248.

A Case of Ascites and Extensive Abdominal Distension Caused by Reversible Pulmonary Arterial Hypertension Associated with Graves' Disease

• Choi B
• Eom YS
• Kim SH
• Choi HS
• Chung WJ
• Lee S

• KMID: 2169177
• DOI: http://doi.org/10.3803/EnM.2011.26.3.248

Abstract

Patients with hyperthyroidism can develop left ventricular dysfunction and heart failure, but severe pulmonary hypertension association with hyperthyroidism is rarely seen. Herein, we describe the case of a 27-year-old female who presented with abdominal distension accompanied by pulmonary arterial hypertension and Graves' disease. Her pulmonary arterial hypertension was improved by treating the hyperthyroidism and pulmonary artery hypertension. Additionally, the patient's symptoms of right-side heart failure improved after pulmonary arterial pressure was reduced. Hyperthyroidism should be regarded as a reversible cause of associated pulmonary arterial hypertension.

Keyword

Graves' disease; Pulmonary arterial hypertension

MeSH Terms

Adult
Arterial Pressure
Ascites
Female
Graves Disease
Heart Failure
Humans
Hypertension
Hypertension, Pulmonary
Hyperthyroidism
Pulmonary Artery
Ventricular Dysfunction, Left
Hypertension, Pulmonary

Figure

• 

  Fig. 1 Abdominopelvic CT showed a large amount of peritoneal ascites and right pleural effusion.

• 

  Fig. 2 Echocardiography in 27-year-old woman with Graves' disease and severe pulmonary arterial hypertension. A. Right ventricle (RV) was markedly enlarged. Interventricular septum was flattened and left ventricle (LV) was got out of its shape into a 'D-shape'. B. The apical four-chamber view showed markedly enlarged right ventricle and right atrium. C. Doppler echocardiography showed moderate tricuspid regurgitation. D. A pressure gradient between the right ventricle and right atrium was 59.6 mmHg.

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  Fig. 3 Follow-up echocardiography after proper treatment of hyperthyroidism and pulmonary arterial hypertension. A. The D-shape of left ventricle (LV) was nearly disappeared. B. Peak systolic pulmonary artery pressure decreased from 74.6 mmHg to 49.39 mmHg. RV, right ventricle.

Reference

1. Klein I, Ojamaa K. Thyroid hormone and the cardiovascular system. N Engl J Med. 2001. 344:501–509.

2. Marvisi M, Brianti M, Marani G, Del Borello R, Bortesi ML, Guariglia A. Hyperthyroidism and pulmonary hypertension. Respir Med. 2002. 96:215–220.

3. Klein I, Danzi S. Thyroid disease and the heart. Circulation. 2007. 116:1725–1735.

4. Kahaly GJ, Dillmann WH. Thyroid hormone action in the heart. Endocr Rev. 2005. 26:704–728.

5. Siu CW, Yeung CY, Lau CP, Kung AW, Tse HF. Incidence, clinical characteristics and outcome of congestive heart failure as the initial presentation in patients with primary hyperthyroidism. Heart. 2007. 93:483–487.

6. Cohen J, Schattner A. Right heart failure and hyperthyroidism: a neglected presentation. Am J Med. 2003. 115:76–77.

7. Ismail HM. Reversible pulmonary hypertension and isolated right-sided heart failure associated with hyperthyroidism. J Gen Intern Med. 2007. 22:148–150.

8. Marvisi M, Zambrelli P, Brianti M, Civardi G, Lampugnani R, Delsignore R. Pulmonary hypertension is frequent in hyperthyroidism and normalizes after therapy. Eur J Intern Med. 2006. 17:267–271.

9. Armigliato M, Paolini R, Aggio S, Zamboni S, Galasso MP, Zonzin P, Cella G. Hyperthyroidism as a cause of pulmonary arterial hypertension: a prospective study. Angiology. 2006. 57:600–606.

10. Siu CW, Zhang XH, Yung C, Kung AW, Lau CP, Tse HF. Hemodynamic changes in hyperthyroidism-related pulmonary hypertension: a prospective echocardiographic study. J Clin Endocrinol Metab. 2007. 92:1736–1742.

11. Danzi S, Klein I. Thyroid hormone and blood pressure regulation. Curr Hypertens Rep. 2003. 5:513–520.

12. Nakchbandi IA, Wirth JA, Inzucchi SE. Pulmonary hypertension caused by Graves' thyrotoxicosis: normal pulmonary hemodynamics restored by (131)I treatment. Chest. 1999. 116:1483–1485.

13. Agraou B, Tricot O, Strecker A, Bresson R, Leroy F, Langlois P, Lauwerier B, Dujardin JJ. Hyperthyroidism associated with pulmonary hypertension. Arch Mal Coeur Vaiss. 1996. 89:765–768.

14. Silva DR, Gazzana MB, John AB, Siqueira DR, Maia AL, Barreto SS. Pulmonary arterial hypertension and thyroid disease. J Bras Pneumol. 2009. 35:179–185.

15. Soroush-Yari A, Burstein S, Hoo GW, Santiago SM. Pulmonary hypertension in men with thyrotoxicosis. Respiration. 2005. 72:90–94.

16. Lozano HF, Sharma CN. Reversible pulmonary hypertension, tricuspid regurgitation and right-sided heart failure associated with hyperthyroidism: case report and review of the literature. Cardiol Rev. 2004. 12:299–305.

17. Merce J, Ferras S, Oltra C, Sanz E, Vendrell J, Simon I, Camprubi M, Bardaji A, Ridao C. Cardiovascular abnormalities in hyperthyroidism: a prospective Doppler echocardiographic study. Am J Med. 2005. 118:126–131.