Cor Pulmonale Secondary to Severe Pulmonary Hypertension As the First Manifestation of Graves' Disease

Pulmonary hypertension (PH), especially if severe, carries a significant morbidity and mortality. Herein we describe a case of an 88-year-old woman with severe heart failure and several hospitalizations that year for the same reason, rapid re-admission after discharge and loss of walking ability. Transthoracic echocardiography (TTE) revealed severe pulmonary hypertension (PASP=69 mmHg) and right ventricular dysfunction without left structural or functional dysfunction. Pulmonary thromboembolism, relevant pulmonary pathology was excluded, and an extended autoimmune study was also negative. Thyroid disorders were investigated, a Graves' disease with thyrotoxicosis was diagnosed and promptly treated with thiamazole, also known as methimazole. There was a rapid improvement in the clinical and hemodynamic status of the patient, stabilization of the right heart failure (HF), resolution of the volume overload and a TTE showed improvement with moderate PH (PASP=55 mmHg). This case shows a reversible cause of PH and highlights how treatment of Graves' disease can reduce pulmonary artery pressure and contribute to symptomatic relief and better quality of life.