methimazole and Mitral-Valve-Insufficiency

Mitral valve prolapse is a common finding in Graves' disease. However, severe mitral regurgitation (MR) is a relatively uncommon manifestation of Graves' disease. We report a case of a 32-year-old woman with toxic Graves' disease and MR. The echocardiogram was suggestive of severe MR with biventricular failure, severe enough to be considered for mitral valve replacement. With medical control of the thyrotoxic state, a repeat echocardiogram revealed only trace MR, with normal left ventricular function. The timely management of the thyrotoxic state in this patient with Graves' disease and moderate to severe MR possibly related to myxomatous degeneration, averted the need for mitral valve replacement.

Topics: Adrenergic beta-Antagonists; Adult; Antithyroid Agents; Echocardiography; Fatigue; Female; Graves Disease; Humans; Hyperthyroidism; Methimazole; Mitral Valve Insufficiency; Propranolol

An association between mitral valve prolapse (MVP) and hyperthyroidism has been described in adults. However, the long-term prognosis when associated with significant mitral regurgitation remains unclear. Three consecutive children with Graves' disease were found to have a loud mitral regurgitation murmur (grade III/VI) and echocardiographic evidence of MVP with moderate mitral regurgitation. The cardiac manifestations included palpitations, exertional dyspnea, and exercise intolerance. The electrocardiograms at presentation were sinus tachycardia in all cases. All had hyperthyroidism and positive thyroid antibodies. Exophthalmos occurred in two and appeared later than the cardiac symptoms in one. The cardiac murmur disappeared in all patients when antithyroid agents controlled the hyperthyroidism. Follow-up echocardiography showed normal in one and MVP with mild mitral regurgitation in two. We conclude that MVP and significant mitral regurgitation can occur in children with hyperthyroidism, especially those with Graves' disease. The prognosis is good after adequate medical control of the hyperthyroidism.

Topics: Adolescent; Child; Child, Preschool; Female; Follow-Up Studies; Graves Disease; Humans; Methimazole; Mitral Valve Insufficiency; Mitral Valve Prolapse; Risk Assessment; Severity of Illness Index; Thyroid Function Tests; Treatment Outcome

Topics: Adult; Cardiac Catheterization; Electrocardiography; Female; Heart Ventricles; Humans; Hyperthyroidism; Methimazole; Mitral Valve Insufficiency; Myocardial Infarction; Phonocardiography; Radiography

Topics: Adult; Arrhythmia, Sinus; Atrial Fibrillation; Cardiac Complexes, Premature; Electrocardiography; Heart Block; Heart Ventricles; Humans; Hyperthyroidism; Male; Methimazole; Middle Aged; Mitral Valve Insufficiency; Myocardial Infarction; Propranolol; Respiration