A Case of Pulmonary Hypertension Recurred by Graves’ Disease

Article information

Kosin Med J. 2013;28(2):171-176
Publication date (electronic) : 2013 January 19
doi : https://doi.org/10.7180/kmj.2013.28.2.171
Department of Internal Medicine, College of Medicine, Kosin University, Busan, Korea
Corresponding author: Young Sik Choi, Department of Internal Medicine, College of Medicine, Kosin University, 34 Amnam dong, Seo-gu, Busan 602-702, Korea TEL: +82-51-990-6102 FAX: +82-51-248-5686 E-mail: yschoi@ns.kosinmed.or.kr
Received 2012 April 26; 2012 June 21; Accepted 2012 June 25.

Abstract

A few cases of severe pulmonary hypertension with right heart failure associated with Graves’ disease were reported in the literature. However, cases of pulmonary hypertension with right heart failure recurred by Graves’ disease is very rare. We describe the case of a 60-year old woman who had been treated pulmonary hypertension caused by right pulmonary artery thromboembolism seven years ago. Recently, her pulmonary hypertension with right heart failure was recurred by Graves’ disease. The patient’s symptoms of pulmonary hypertension was resolved after treatment of Graves’ disease.

Fig. 1.

(A) Huge sized thrombus in right pulmonary artery was showed in chest CT of 7 years before admission, (B) On admission day, chest CT revealed no evidence of pulmonary arterial thrombus.

Fig. 2.

On admission day, the electrocardiography showed normal sinus rhythm, right ventricular hypertrophy and ST depression in pre-cordial leads.

Fig. 3.

On admission day, transthoracic-echocardiography revealed severe pulmonary hypertension. (A) Pressure gradient between right atrium and ventricle is 85.7 mmHg, (B) Right ventricle is markedly enlarged. Left ventricle showed D-shape appearance.

Fig. 4.

Ultrasonography of the thyroid. (A) Sonogram showed diffuse enlarged thyroid gland with heterogenous echogenecity (0.92 cm of isthmus, 2.7 cm of right lobe, 2.36 cm of left lobe), (B) Sonogram presented thyroid gland with hypervascularity.

Fig. 5.

Non-visualization of both thyroid lobes (I-131 uptake = 1%).

References

1. Galiè N, Hoeper MM, Humbert M, Torbicki A, Vachiery JL, Barbera JA, et al. Guidelines for the diagnosis and treatment of pulmonary hypertension. Eur Heart J 2009;30:2493–537.
2. Simonneau G, Robbins IM, Beghetti M, Channick RN, Delcroix M, Denton CP, et al. Updated clinical classification of pulmonary hypertension. J Am Coll Cardiol 2009;54:S43–54.
3. Yoon HJ, Jin SW, Jung SJ, Jang SH, Lee JM, Kim JH, et al. A case of hyperthyroidism as a cause of pulmonary hypertension. Korean J Med 2003;65:S773–6.
4. Choi BH, Eom YS, Kim SH, Choi HS, Chung WJ, Lee SH. A case of ascites and extensive abdominal distension caused by reversible pulmonary arterial hypertension associated with Graves'disease. Endocrinol Metab 2011;26:248–52.
5. Klein I, Ojamaa K. Thyroid hormone and the cardiovascular system. N Engl J Med 2001;344:501–9.
6. Chu JW, Kao PN, Faul JL, Doyle RL. High prevalence of autoimmune thyroid disease in pulmonary arterial hypertension. Chest 2002;122:1668–73.
7. Suk JH, Cho KI, Lee SH, Lee HG, Kim SM, Kim TI, et al. Prevalence of echocardiographic criteria for the diagnosis of pulmonary hypertension in patients with Graves' disease: before and after antithyroid treatment. J Endocrinol Invest 2011;34:e229–34.
8. Voelkel MA, Wynne KM, Badesch DB, Groves BM, Voelkel NF. Hyperuricemia in severe pulmonary hypertension. Chest 2000;117:19–24.
9. Nagaya N, Nishikimi T, Uematsu M, Satoh T, Kyotani S, Sakamaki F, et al. Plasma brain natriuretic peptide as a prognostic indicator in patients with primary pulmonary hypertension. Circulation 2000;102:865–70.
10. Andreassen AK, Wergeland R, Simonsen S, Geiran O, Guevara C, Ueland T. N-terminal pro-B-type natriuretic peptide as an indicator of disease severity in a heterogeneous group of patients with chronic precapillary pulmonary hypertension. Am J Cardiol 2006;98:525–9.

Article information Continued

Fig. 1.

(A) Huge sized thrombus in right pulmonary artery was showed in chest CT of 7 years before admission, (B) On admission day, chest CT revealed no evidence of pulmonary arterial thrombus.

Fig. 2.

On admission day, the electrocardiography showed normal sinus rhythm, right ventricular hypertrophy and ST depression in pre-cordial leads.

Fig. 3.

On admission day, transthoracic-echocardiography revealed severe pulmonary hypertension. (A) Pressure gradient between right atrium and ventricle is 85.7 mmHg, (B) Right ventricle is markedly enlarged. Left ventricle showed D-shape appearance.

Fig. 4.

Ultrasonography of the thyroid. (A) Sonogram showed diffuse enlarged thyroid gland with heterogenous echogenecity (0.92 cm of isthmus, 2.7 cm of right lobe, 2.36 cm of left lobe), (B) Sonogram presented thyroid gland with hypervascularity.

Fig. 5.

Non-visualization of both thyroid lobes (I-131 uptake = 1%).