methimazole and Heart-Failure

Hyperthyroidism, such as Basedow disease, causes fluid retention, although the common cause is volume overload due to congestive heart failure. In addition, hyperthyroidism and Basedow disease are known to cause pulmonary hypertension. Edematous thickening of the gallbladder wall is caused by venous blood congestion. The feature of edematous wall thickening of the gallbladder on abdominal computed tomography (CT) is subserosal edema and is often accompanied by a periportal collar sign.. A 30-year-old woman was referred to our hospital because of liver dysfunction, edematous gallbladder wall thickening, and fluid retention. In addition, the patient developed hyperthyroidism and heart failure. Enhanced abdominal CT revealed edematous wall thickening of the gallbladder and a periportal collar sign.. We suspected that fluid retention and congestion were caused by hyperthyroidism and Basedow disease.. On admission, we started thiamazole therapy for Basedow disease, and her thyroid hormone levels normalized.. Abdominal CT revealed disappearance of edematous wall thickening of the gallbladder, which was likely associated with an improvement in thyroid function. The patient was discharged 10 days after admission.. We encountered a case of hyperthyroidism and Basedow disease accompanied by edematous wall thickening of the gallbladder and various fluid retentions as the first symptoms. Such edematous wall thickening of the gallbladder and various fluid retentions were reduced, together with the improvement of hyperthyroidism.

Topics: Adult; Edema; Female; Gallbladder; Graves Disease; Heart Failure; Humans; Hyperthyroidism; Methimazole; Tomography, X-Ray Computed; Treatment Outcome; Ultrasonography

Topics: Abdominal Pain; Antithyroid Agents; Ascites; Atrial Fibrillation; Diagnosis, Differential; Echocardiography, Transesophageal; Electrocardiography; Female; Heart Failure; Humans; Hyperthyroidism; Magnetic Resonance Imaging, Cine; Medication Adherence; Methimazole; Metoprolol; Middle Aged; Paracentesis; Thyroid Function Tests

Topics: Adult; Antithyroid Agents; Computed Tomography Angiography; Conservative Treatment; Echocardiography, Transesophageal; Electrocardiography; Female; Graves Disease; Heart Failure; Humans; Hypertension, Pulmonary; Image Processing, Computer-Assisted; Methimazole; Propylthiouracil; Scimitar Syndrome; Thyroid Function Tests; Treatment Outcome; Tricuspid Valve Insufficiency; Vena Cava, Inferior

We report a case of apathetic hyperthyroidism associated with unrecognized slowly growing functional thyroid adenoma (Plummer's disease), atrial fibrillation and heart failure. An 81-year-old woman with worsening thyroid dysfunction was admitted to our hospital for the treatment of heart failure. The patient had developed heart failure associated with chronic atrial fibrillation at 76 years of age, and one year later was found to have asymptomatic hyperthyroidism. Anti-thyroid autoantibodies were negative, but thyroid echography showed a 32-mm tumor devoid of internal blood flow in the left lower lobe. Free thyroxine 4 (FT4) decreased from 3.30 to 2.60 ng/dl without treatment. The patient was diagnosed with transient thyroiditis and was followed-up without treatment. However, a repeat thyroid echography showed growth of the tumor to 41 mm in 4 years. Thyroid scintigraphy showed uptake that matched the thyroid mass. Based on these findings, the established diagnosis was Plummer's disease complicated with heart failure. The patient was treated with anti-thyroid drugs, which resulted in improvement of FT4 and reduced the severity of heart failure. In this rare case of an elderly patient, Plummer's disease was associated with a slowly-growing functional thyroid adenoma, apathetic hyperthyroidism, repeated episodes of atrial fibrillation and heart failure. Since symptoms of thyrotoxicosis are likely to be missed in the elderly, it is necessary to include hyperthyroidism in the pathoetiology of heart failure and atrial fibrillation in this population.

Topics: Aged, 80 and over; Antithyroid Agents; Atrial Fibrillation; Female; Goiter, Nodular; Heart Failure; Humans; Hyperthyroidism; Methimazole; Receptors, Thyrotropin; Recurrence; Thyrotoxicosis; Treatment Outcome

Neonatal hyperthyroidism is usually a self-limited condition frequently associated with transplacental passage of thyroid stimulating antibodies secondary to maternal autoimmune disorders. To timely detect mothers with this medical antecedents decreases the risk for fetal adverse events.. To report a case of neonatal hyperthyroidism associated with intrauterine growth restriction and heart failure.. A 36 week-old newborn with birth weight of 1,240 g. Symptoms were tachycardia, distal coldness, exophthalmos, hepatomegaly and tremors. Echocardiogram ruled out structural heart disorders. Due to maternal symptoms suggestive of hyperthyroidism, TSH tests were performed showing 0.01 ulU/ml, free T4 7.7 ng/dl, so the diagnosis of neonatal hyperthyroidism was confirmed. It was treated with methimazole and propanol, alleviating the symptoms and decreasing the levels of free T4.. To know the maternal history helps identify and manage neonatal complications of hyperthyroidism. Heart failure and other cardiopulmonary disorders are determinants of mortality during early neonatal period. High-risk newborns should receive follow up assessments.

Topics: Adrenergic beta-Antagonists; Antithyroid Agents; Fetal Growth Retardation; Heart Failure; Humans; Hyperthyroidism; Infant, Newborn; Male; Methimazole; Propranolol; Thyroxine

We describe a case of severe congestive heart failure and right ventricular overload associated with overt hyperthyroidism, completely reversed with antithyroid therapy in a few week. It represents a very unusual presentation of overt hyperthyroidism because of the severity of right heart failure. The impressive right ventricular volume overload made mandatory to perform transesophageal echo and angio-TC examination to exclude the coexistence of ASD or anomalous pulmonary venous return. Only a few cases of reversible right heart failure, with or without pulmonary hypertension, have been reported worldwide. In our case the most striking feature has been the normalization of the cardiovascular findings after six weeks of tiamazole therapy.

Topics: Adrenergic beta-Antagonists; Drug Therapy, Combination; Dyspnea; Echocardiography, Transesophageal; Electrocardiography; Female; Follow-Up Studies; Furosemide; Heart Failure; Heparin, Low-Molecular-Weight; Humans; Hyperthyroidism; Methimazole; Middle Aged; Recovery of Function; Risk Assessment; Severity of Illness Index; Thyroid Function Tests; Treatment Outcome; Ventricular Dysfunction, Right

Hyperthyroidism may present with signs and symptoms related to dysfunction of a variety of organs. Cardiovascular pathology in hyperthyroidism is common. A few case reports describe isolated right heart failure, tricuspid regurgitation, and pulmonary hypertension as the prominent cardiovascular manifestations of hyperthyroidism. Although most textbooks do not mention hyperthyroidism as a cause of pulmonary hypertension and isolated right heart failure, the literature suggests that some hyperthyroid patients may develop reversible pulmonary hypertension and isolated right heart failure. We report a case of hyperthyroidism presenting with signs and symptoms of isolated right heart failure, tricuspid regurgitation, and pulmonary hypertension, which resolved with treatment of hyperthyroidism.

Topics: Antithyroid Agents; Female; Graves Disease; Heart Failure; Humans; Hypertension, Pulmonary; Methimazole; Middle Aged; Tricuspid Valve Insufficiency; Ventricular Dysfunction, Right

We report a 49-year-old man with primary hyperthyroidism who presented with pancytopenia. The patient presented with leg edema, sinus tachycardia, cardiomegaly, and pleural effusions, all from congestive heart failure. Laboratory data showed pancytopenia and primary hyperthyroidism; echocardiogram showed diffuse hyperkinesis of the left ventricular wall and right ventricular overloading. The bone marrow was moderately hypercellular and compatible with arrested hematopoiesis. Pancytopenia and heart failure improved after administration of methimazole and diuretics. However, high levels of thyroid hormone recurred with pancytopenia 4 months after admission. Therefore, subtotal thyroidectomy was performed, and the levels of thyroid hormones and peripheral blood cell counts have remained normal. Pancytopenia may be caused by hyperthyroidism.

Topics: Antithyroid Agents; Blood Cell Count; Bone Marrow; Cardiomegaly; Diuretics; Edema; Heart Failure; Humans; Leg; Male; Methimazole; Middle Aged; Pancytopenia; Pleural Effusion; Recurrence; Tachycardia, Sinus; Thyroidectomy; Thyrotoxicosis

A 58-year-old woman was admitted because of jaundice, ascites and marked oedema. For three years she had suffered from nervousness, decreasing fitness and weight loss, which had been assumed as due to chronic alcoholism. Liver biopsy revealed extensive fibrosis, in part with early cirrhotic transformation. This was followed by cardiac failure with atrial fibrillation (ventricular rate 140/min) and marked pleural effusions. The thyroid was diffusely enlarged and there were signs of exophthalmos.. Bilirubin concentration was 3 mg/dl, lactate dehydrogenase activity was 310 U/l, cholesterase 1.3 kU/l and the prothrombin test was 21%. The TSH level was 0.01 microU/ml while the free thyroxine level was 4.7 ng/dl and that of free triiodothyronine 13.5 pg/ml. Chest radiograph revealed cardiomegaly, bilateral peripheral pulmonary congestion and pleural effusions to midfield. Right heart catheterization excluded pulmonary hypertension; cardiac output was 10l/min. The thyroid was enlarged on ultrasound and diffusely echopoor, as in immune thyroid disease.. Cardiac failure regressed and thyroid function normalized within ten days on propranolol, 4 x 40 mg and thiamazole 3 x 40 mg daily intravenously. Subtotal thyroidectomy was performed three weeks later with subsequent thyroid hormone substitution. Liver functions were normal six months later and ultrasound showed no signs of cirrhotic change and the ascites had resolved.. Hyperthyroidism is frequently associated with changes in liver functions. In extreme cases, high-output cardiac failure may occur, with liver congestion and clinical as well as histological changes like those in liver cirrhosis.

Topics: Adrenergic beta-Antagonists; Anti-Arrhythmia Agents; Antithyroid Agents; Arrhythmias, Cardiac; Autoimmune Diseases; Female; Heart Failure; Humans; Hyperthyroidism; Liver Cirrhosis; Methimazole; Middle Aged; Propranolol; Thyroid Hormones; Thyroidectomy; Ultrasonography

Topics: Agranulocytosis; Animals; Antibodies; Antigen-Antibody Complex; Antithyroid Agents; Basophils; Cytoplasm; Cytoplasmic Granules; Drug Eruptions; Eosinophilia; Eosinophils; Female; Guinea Pigs; Heart Failure; Humans; Hyperthyroidism; Imidazoles; Immunoassay; Jaundice; Leukocyte Count; Methimazole; Middle Aged; Neutrophils