Ann Pediatr Endocrinol Metab.  2016 Jun;21(2):92-95. 10.6065/apem.2016.21.2.92.

Dilated cardiomyopathy with Graves disease in a young child

Affiliations
  • 1Department of Pediatrics, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea. nicedoc@catholic.ac.kr

Abstract

Graves disease (GD) can lead to complications such as cardiac arrhythmia and heart failure. Although dilated cardiomyopathy (DCMP) has been occasionally reported in adults with GD, it is rare in children. We present the case of a 32-month-old boy with DCMP due to GD. He presented with irritability, vomiting, and diarrhea. He also had a history of weight loss over the past few months. On physical examination, he had tachycardia without fever, a mild diffuse goiter, and hepatomegaly. The chest radiograph showed cardiomegaly with pulmonary edema, while the echocardiography revealed a dilated left ventricle with an ejection fraction (EF) of 28%. The thyroid function test (TFT) showed elevated serum T3 and decreased thyroid stimulating hormone (TSH) levels. The TSH receptor autoantibody titer was elevated. He was diagnosed with DCMP with GD; treatment with methylprednisolone, diuretics, inotropics, and methimazole was initiated. The EF improved after the TFT normalized. At follow-up several months later, although the TFT results again showed evidence of hyperthyroidism, his EF had not deteriorated. His cardiac function continues to remain normal 1.5 months after treatment was started, although he still has elevated T3 and high TSH receptor antibody titer levels due to poor compliance with drug therapy. To summarize, we report a young child with GD-induced DCMP who recovered completely with medical therapy and, even though the hyperthyroidism recurred several months later, there was no relapse of the DCMP.

Keyword

Dilated cardiomyopathy; Child; Graves disease

MeSH Terms

Adult
Arrhythmias, Cardiac
Cardiomegaly
Cardiomyopathy, Dilated*
Child*
Child, Preschool
Compliance
Deoxycytidine Monophosphate
Diarrhea
Diuretics
Drug Therapy
Echocardiography
Fever
Follow-Up Studies
Goiter
Graves Disease*
Heart Failure
Heart Ventricles
Hepatomegaly
Humans
Hyperthyroidism
Male
Methimazole
Methylprednisolone
Physical Examination
Pulmonary Edema
Radiography, Thoracic
Receptors, Thyrotropin
Recurrence
Tachycardia
Thyroid Function Tests
Thyrotropin
Vomiting
Weight Loss
Deoxycytidine Monophosphate
Diuretics
Methimazole
Methylprednisolone
Receptors, Thyrotropin
Thyrotropin

Figure

  • Fig. 1 (A) Chest roentgenogram shows cardiomegaly and pulmonary edema and (B) echocardiography shows severe atrioventricular valves regurgitation and cardiomegaly on apical 4-chamber view.


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