Reversible severe tricuspid regurgitation associated with Graves’ disease: A case report

RATIONALE: Graves’ disease is the most common cause of thyrotoxicosis. Cardiovascular signs and symptoms are frequent in patients with thyrotoxicosis and right heart failure with severe tricuspid regurgitation (TR) is a rare manifestation of hyperthyroidism. PATIENT CONCERNS: A 41-year-old woman with a history of Graves’ disease presented to the emergency department with worsening generalized edema and dyspnea for a month. DIAGNOSIS: The laboratory test results revealed suppressed thyroid-stimulating hormone (TSH), elevated levels of free thyroxine and anti-TSH receptor antibody, and negative anti-thyroid peroxidase and anti-thyroglobulin antibodies. Transthoracic echocardiography showed severe TR associated with incomplete coaptation of tricuspid valve due to dilated right ventricle (RV), moderate resting pulmonary hypertension, and preserved biventricular systolic function. INTERVENTIONS AND OUTCOMES: After 6 months of antithyroid treatment, her thyroid function was restored euthyroid state and she was fully recovered from right heart failure. Follow-up echocardiography showed complete disappearance of severe TR and pulmonary hypertension and normalization of RV dimension. LESSONS: Severe TR can be rarely associated with thyrotoxicosis, but this is reversible and can be completely recovered with normalization of thyroid function.