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Right ventricular dysfunction and pulmonary hypertension: a neglected presentation of thyrotoxicosis

Thyrotoxicosis is associated with cardiac dysfunction; more commonly, left ventricular dysfunction. However, in recent years, there have been more cases reported on right ventricular dysfunction, often associated with pulmonary hypertension in patients with thyrotoxicosis. Three cases of thyrotoxico...

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Autores principales: Singarayar, Carolina Shalini, Siew Hui, Foo, Cheong, Nicholas, Swee En, Goay
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Bioscientifica Ltd 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5955009/
https://www.ncbi.nlm.nih.gov/pubmed/29785271
http://dx.doi.org/10.1530/EDM-18-0012
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author Singarayar, Carolina Shalini
Siew Hui, Foo
Cheong, Nicholas
Swee En, Goay
author_facet Singarayar, Carolina Shalini
Siew Hui, Foo
Cheong, Nicholas
Swee En, Goay
author_sort Singarayar, Carolina Shalini
collection PubMed
description Thyrotoxicosis is associated with cardiac dysfunction; more commonly, left ventricular dysfunction. However, in recent years, there have been more cases reported on right ventricular dysfunction, often associated with pulmonary hypertension in patients with thyrotoxicosis. Three cases of thyrotoxicosis associated with right ventricular dysfunction were presented. A total of 25 other cases of thyrotoxicosis associated with right ventricular dysfunction published from 1994 to 2017 were reviewed along with the present 3 cases. The mean age was 45 years. Most (82%) of the cases were newly diagnosed thyrotoxicosis. There was a preponderance of female gender (71%) and Graves’ disease (86%) as the underlying aetiology. Common presenting features included dyspnoea, fatigue and ankle oedema. Atrial fibrillation was reported in 50% of the cases. The echocardiography for almost all cases revealed dilated right atrial and or ventricular chambers with elevated pulmonary artery pressure. The abnormal echocardiographic parameters were resolved in most cases after rendering the patients euthyroid. Right ventricular dysfunction and pulmonary hypertension are not well-recognized complications of thyrotoxicosis. They are life-threatening conditions that can be reversed with early recognition and treatment of thyrotoxicosis. Signs and symptoms of right ventricular dysfunction should be sought in all patients with newly diagnosed thyrotoxicosis, and prompt restoration of euthyroidism is warranted in affected patients before the development of overt right heart failure. LEARNING POINTS: Thyrotoxicosis is associated with right ventricular dysfunction and pulmonary hypertension apart from left ventricular dysfunction described in typical thyrotoxic cardiomyopathy. Symptoms and signs of right ventricular dysfunction and pulmonary hypertension should be sought in all patients with newly diagnosed thyrotoxicosis. Thyrotoxicosis should be considered in all cases of right ventricular dysfunction or pulmonary hypertension not readily explained by other causes. Prompt restoration of euthyroidism is warranted in patients with thyrotoxicosis complicated by right ventricular dysfunction with or without pulmonary hypertension to allow timely resolution of the abnormal cardiac parameters before development of overt right heart failure.
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spelling pubmed-59550092018-05-21 Right ventricular dysfunction and pulmonary hypertension: a neglected presentation of thyrotoxicosis Singarayar, Carolina Shalini Siew Hui, Foo Cheong, Nicholas Swee En, Goay Endocrinol Diabetes Metab Case Rep Unique/Unexpected Symptoms or Presentations of a Disease Thyrotoxicosis is associated with cardiac dysfunction; more commonly, left ventricular dysfunction. However, in recent years, there have been more cases reported on right ventricular dysfunction, often associated with pulmonary hypertension in patients with thyrotoxicosis. Three cases of thyrotoxicosis associated with right ventricular dysfunction were presented. A total of 25 other cases of thyrotoxicosis associated with right ventricular dysfunction published from 1994 to 2017 were reviewed along with the present 3 cases. The mean age was 45 years. Most (82%) of the cases were newly diagnosed thyrotoxicosis. There was a preponderance of female gender (71%) and Graves’ disease (86%) as the underlying aetiology. Common presenting features included dyspnoea, fatigue and ankle oedema. Atrial fibrillation was reported in 50% of the cases. The echocardiography for almost all cases revealed dilated right atrial and or ventricular chambers with elevated pulmonary artery pressure. The abnormal echocardiographic parameters were resolved in most cases after rendering the patients euthyroid. Right ventricular dysfunction and pulmonary hypertension are not well-recognized complications of thyrotoxicosis. They are life-threatening conditions that can be reversed with early recognition and treatment of thyrotoxicosis. Signs and symptoms of right ventricular dysfunction should be sought in all patients with newly diagnosed thyrotoxicosis, and prompt restoration of euthyroidism is warranted in affected patients before the development of overt right heart failure. LEARNING POINTS: Thyrotoxicosis is associated with right ventricular dysfunction and pulmonary hypertension apart from left ventricular dysfunction described in typical thyrotoxic cardiomyopathy. Symptoms and signs of right ventricular dysfunction and pulmonary hypertension should be sought in all patients with newly diagnosed thyrotoxicosis. Thyrotoxicosis should be considered in all cases of right ventricular dysfunction or pulmonary hypertension not readily explained by other causes. Prompt restoration of euthyroidism is warranted in patients with thyrotoxicosis complicated by right ventricular dysfunction with or without pulmonary hypertension to allow timely resolution of the abnormal cardiac parameters before development of overt right heart failure. Bioscientifica Ltd 2018-05-16 /pmc/articles/PMC5955009/ /pubmed/29785271 http://dx.doi.org/10.1530/EDM-18-0012 Text en © 2018 The authors http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en_GB This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en_GB) .
spellingShingle Unique/Unexpected Symptoms or Presentations of a Disease
Singarayar, Carolina Shalini
Siew Hui, Foo
Cheong, Nicholas
Swee En, Goay
Right ventricular dysfunction and pulmonary hypertension: a neglected presentation of thyrotoxicosis
title Right ventricular dysfunction and pulmonary hypertension: a neglected presentation of thyrotoxicosis
title_full Right ventricular dysfunction and pulmonary hypertension: a neglected presentation of thyrotoxicosis
title_fullStr Right ventricular dysfunction and pulmonary hypertension: a neglected presentation of thyrotoxicosis
title_full_unstemmed Right ventricular dysfunction and pulmonary hypertension: a neglected presentation of thyrotoxicosis
title_short Right ventricular dysfunction and pulmonary hypertension: a neglected presentation of thyrotoxicosis
title_sort right ventricular dysfunction and pulmonary hypertension: a neglected presentation of thyrotoxicosis
topic Unique/Unexpected Symptoms or Presentations of a Disease
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5955009/
https://www.ncbi.nlm.nih.gov/pubmed/29785271
http://dx.doi.org/10.1530/EDM-18-0012
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