propylthiouracil and Heart-Failure

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

A 30-year-old female patient with a past medical history of pernicious anaemia presented with pleuritic chest pain, palpitations, fatigue, coryzal symptoms and a high temperature. She was hypoxic and tachycardic and was extensively investigated as well as aggressively treated. A type 1 'gut feeling' assessment by the admitting medical registrar made the diagnosis possible as thyroid function tests were grossly deranged and pointed to Graves' disease causing heart failure, complicated by pneumonia. The patient was discharged on carbimazole, antibiotics and beta blockers. Due to a resultant thrombocytopaenia, she has now been swapped onto propylthiouracil and is under active follow up.

Topics: Adult; Antithyroid Agents; Female; Graves Disease; Heart Failure; Humans; Propylthiouracil; Thyrotoxicosis

A 52-year-old woman, who had an out-of-hospital cardiac arrest, was resuscitated, intubated and transferred with cardiogenic shock to angioplasty of the right coronary artery. Afterwards the patient had normal biventricular function, but four days later she developed atrial fibrillation and recurrent cardiogenic shock with a left ventricular ejection fraction of 20%. Thyrotoxic crisis was determined as the underlying cause; and antithyroid treatment stabilised the patient's haemodynamics completely within 24 hours. The importance of high thyroxine levels in patients with ischaemic heart disease is discussed.

Topics: Antithyroid Agents; Cardiovascular System; Female; Heart Failure; Humans; Middle Aged; Out-of-Hospital Cardiac Arrest; Potassium Iodide; Propylthiouracil; Radionuclide Imaging; Thyroid Crisis; Thyroid Hormones

High titer of maternal thyroid-stimulating hormone receptor antibody (TRAb) in patients with Graves' disease could cause fetal hyperthyroidism during pregnancy. Clinical features of fetal hyperthyroidism include tachycardia, goiter, growth restriction, advanced bone maturation, cardiomegaly, and fetal death. The recognition and treatment of fetal hyperthyroidism are believed to be important to optimize growth and intellectual development in affected fetuses. We herein report a case of fetal treatment in two successive siblings showing in utero hyperthyroid status in a woman with a history of ablative treatment for Graves' disease. The fetuses were considered in hyperthyroid status based on high levels of maternal TRAb, a goiter, and persistent tachycardia. In particular, cardiac failure was observed in the second fetus. With intrauterine treatment using potassium iodine and propylthiouracil, fetal cardiac function improved. A high level of TRAb was detected in the both neonates. To the best of our knowledge, this is the first report on the changes of fetal cardiac function in response to fetal treatment in two siblings showing in utero hyperthyroid status. This case report illustrates the impact of prenatal medication via the maternal circulation for fetal hyperthyroidism and cardiac failure.

Topics: Ablation Techniques; Adult; Antithyroid Agents; Combined Modality Therapy; Dietary Supplements; Female; Goiter; Graves Disease; Heart Failure; Hormone Replacement Therapy; Humans; Hyperthyroidism; Immunoglobulins, Thyroid-Stimulating; Maternal Nutritional Physiological Phenomena; Potassium Iodide; Pregnancy; Pregnancy, High-Risk; Prenatal Care; Prenatal Diagnosis; Propylthiouracil; Recurrence; Thyroxine; Treatment Outcome; Ultrasonography

Although low thyroid function is known to have detrimental effects on the cardiovascular system, including microvascular impairment, little is known about the pathophysiologic consequences of hypothyroidism in the background of hypertension.. Hypothyroidism was induced in female spontaneously hypertensive heart failure (SHHF) rats by treatment with propylthiouracil (PTU) for 6 months. Untreated SHHF and normotensive Wistar Furth (WF) rats served as controls. In terminal experiments, heart weight, echocardiographic measurements, hemodynamics, and arteriolar morphometry were performed. Left ventricular internal diameter in systole and diastole were increased and wall thickness, ejection fraction, heart rate, systolic blood pressure, and +/-dP/dt were significantly decreased in the treatment group. Surprisingly, there were no observed differences in arteriolar density among the 3 groups.. As expected, PTU treatment of SHHF rats led to systolic dysfunction and chamber dilation. However, PTU treatment did not lead to arteriolar loss as previously observed in normotensive rats treated with PTU. These finding suggest that induced hypothyroidism leads to detrimental changes in SHHF rats, but the overall effects were no worse than those previously observed in normotensive rats treated with PTU.

Topics: Animals; Female; Heart Failure; Hemodynamics; Hypertension; Hyperthyroidism; Microcirculation; Myocardium; Propylthiouracil; Rats; Rats, Wistar; Thyroid Gland; Time Factors

Changes in thyroid status are associated with profound alterations in biochemical and physiological functioning of cardiac muscle, although its impact on cardiac energy metabolism is still debated. Similarities between the changes in cardiac gene expression in pathological hypertrophy leading to heart failure and hypothyroidism prompted scientists to suggest a role for thyroid hormone status in the development of metabolic and functional alterations in this disease. We thus investigated the effects of hypothyroidism on cardiac energy metabolism. Hypothyroid state (HYPO) was induced by thyroidectomy and propyl-thio-uracyl in male rats for 3 weeks. We examined the effects of hypothyroid state on oxidative capacity and mitochondrial substrate utilization by measuring oxygen consumption of saponin permeabilized cardiac fibers, mitochondrial biogenesis by reverse transcription polymerase chain reaction and energy metabolism, and energy transfer enzymes by spectrophotometry. The results show that maximal oxidative capacity of the myocardium was decreased from 24.9 +/- 0.9 in control (CT) to 19.3 +/- 0.7 micromol O(2) min(-1) g dry weight(-1) in HYPO. However, protein content and messenger RNA (mRNA) of PGC-1alpha and mRNA of its transcription cascade that is thought to control mitochondrial content in normal myocardium and heart failure, were unchanged in HYPO. Mitochondrial utilization of glycerol-3P (-70%), malate (-45%), and octanoate (-24%) but not pyruvate was decreased in HYPO. Moreover, the creatine kinase system and energy transfer were hardly affected in HYPO. Besides, hypothyroidism decreased the activation of other signaling pathways like p38 mitogen-activated protein kinases, AMP-activated protein kinase, and calcineurin. These results show that cellular hypothyroidism can hardly account for the specific energetic alterations of heart failure.

Topics: AMP-Activated Protein Kinases; Animals; Calcineurin; Electron Transport Complex IV; Energy Metabolism; Energy Transfer; Heart Failure; Hypothyroidism; Intracellular Signaling Peptides and Proteins; Male; Mitochondria, Heart; Multienzyme Complexes; Myocardium; p38 Mitogen-Activated Protein Kinases; Phenotype; Propylthiouracil; Protein Serine-Threonine Kinases; Rats; Rats, Wistar; Signal Transduction; Thyroid Hormones; Transcription Factors

Topics: Antithyroid Agents; Female; Graves Disease; Heart Failure; Humans; Immunoglobulins, Thyroid-Stimulating; Infant, Newborn; Pregnancy; Pregnancy Complications; Propylthiouracil; Thyrotoxicosis

Topics: Antithyroid Agents; Female; Graves Disease; Heart Failure; Humans; Immunoglobulins, Thyroid-Stimulating; Infant, Newborn; Pregnancy; Pregnancy Complications; Propylthiouracil; Thyrotoxicosis

Topics: Acute Disease; Administration, Oral; Adult; Antithyroid Agents; Female; Heart Failure; Humans; Potassium Iodide; Pregnancy; Propylthiouracil; Thyrotoxicosis; Thyrotropin; Thyroxine; Triiodothyronine

Non-immune fetal hydrops is a heterogeneous disorder with a mortality rate of 50-98%. Resolution of non-immune fetal hydrops is rare but has been reported to occur spontaneously or after targeted therapeutic measures.. A euthyroid gravida with Graves disease presented with a history of three prior perinatal deaths between 26 and 28 weeks' gestation, all associated with fetal hydrops. In the current pregnancy, the fetus developed hydrops at 24 weeks' gestation. Fetal hyperthyroidism, with high-output cardiac failure, was diagnosed with fetal blood sampling. After maternal therapy with propylthiouracil, resolution of the non-immune hydrops were documented and a healthy neonate subsequently delivered to term. The neonate developed transient hyperthyroidism after delivery, which required treatment for 10 weeks.. Non-immune hydrops occurring as a result of fetal hyperthyroidism with high output cardiac failure is treatable with propylthiouracil.

Topics: Adult; Antithyroid Agents; Female; Graves Disease; Heart Failure; Humans; Hydrops Fetalis; Hyperthyroidism; Infant, Newborn; Pregnancy; Pregnancy Complications; Propylthiouracil; Recurrence

A case of a pregnant woman who underwent urgent cesarean section is presented. The patient had severe hyperthyroidism, preeclampsia, and congestive heart failure, which had not been treated until 36 weeks of gestational age. At 38 weeks, fetal distress occurred and an urgent cesarean section was performed successfully under epidural anesthesia with preoperative treatments using iodide, hydrocortisone and propylthiouracil. The patient required postoperative intensive care for heart failure. Thyroid function of the neonate was almost normal. No abnormality was observed except low birth weight.

Topics: Adult; Anesthesia, Epidural; Anesthesia, Obstetrical; Cesarean Section; Female; Heart Failure; Humans; Hydrocortisone; Hyperthyroidism; Iodides; Pre-Eclampsia; Pregnancy; Pregnancy Complications, Cardiovascular; Propylthiouracil

This brief report presents a patient with isolated right heart failure and two rare underlying causes, hyperthyroidism and dysplastic tricuspid valve. Repair of the tricuspid valve and treatment of the hyperthyroidism were both essential for successful treatment of the right heart failure. Most important, recrudescence of hyperthyroidism in this patient was associated with reappearance of florid right heart failure. This report provides further information about a potential linkage of hyperthyroidism and severe right heart failure.

Topics: Antithyroid Agents; Echocardiography, Doppler, Color; Echocardiography, Transesophageal; Graves Disease; Heart Failure; Humans; Male; Middle Aged; Propylthiouracil; Tricuspid Valve; Tricuspid Valve Insufficiency

Topics: Aged; Agranulocytosis; Bone Marrow; Heart Failure; Humans; Hyperthyroidism; Leukocyte Count; Male; Propylthiouracil

During the 12-year period from 1974 through 1985, nearly 120,000 women were delivered of infants at Parkland Hospital, and pregnancy was complicated by overt thyrotoxicosis in 60 of them (1:2000). Initial treatment was based on clinical assessment, and propylthiouracil was usually given in doses of 300 to 800 mg daily. In compliant women seen by midpregnancy, euthyroidism was achieved by a mean of 8 weeks; however, the daily dose was decreased to less than or equal to 150 mg by delivery in only 10%. Metabolic status at delivery correlated directly with pregnancy outcome, and women treated earlier in pregnancy were more likely to be euthyroid at delivery and to have good outcomes. Diagnosis of thyrotoxicosis antecedent to pregnancy was associated with earlier treatment, and 80% of 28 such women were euthyroid by delivery. Conversely, 32 women with a first diagnosis during pregnancy had the preponderance of morbidity, including five of six stillbirths and six of seven cases of heart failure. This group was characterized by a relative delay in gestational age at diagnosis. Preterm delivery, perinatal mortality, and maternal heart failure were more common in women who remained thyrotoxic despite treatment and in those who were never treated. Although we infrequently achieved maintenance doses recommended by most, because there were minimal adverse effects from therapy described here and because uncontrolled thyrotoxicosis caused significant maternal and perinatal morbidity, aggressive medical therapy seems appropriate, especially when pregnancy is advanced.

Topics: Adult; Female; Fetal Death; Follow-Up Studies; Heart Failure; Humans; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Propylthiouracil; Risk Factors; Thyroid Diseases; Thyrotoxicosis

Congestive heart failure in neonatal thyrotoxicosis is attributed to sympathetic overstimulation of the myocardium with resulting high-output cardiac failure. An additional case of neonatal thyrotoxicosis with congestive heart failure is discussed; three possible causes (thyrotoxicosis, maternal propranolol therapy, and ventricular septal defect) were present. Along with the usual procedures, the echocardiogram is of value in separating these factors. In addition, we discuss the potential dangers to the newborn of a mother receiving long-term propranolol hydrochloride therapy during pregnancy.

Topics: Digitalis Glycosides; Echocardiography; Female; Graves Disease; Heart Failure; Heart Septal Defects, Ventricular; Humans; Hyperthyroidism; Infant; Infant, Newborn; Pregnancy; Pregnancy Complications; Propranolol; Propylthiouracil

Topics: Female; Heart Diseases; Heart Failure; Humans; Hyperthyroidism; Infant; Infant, Newborn; Long-Acting Thyroid Stimulator; Pregnancy; Propylthiouracil

Topics: Adolescent; Antithyroid Agents; Atrial Fibrillation; Digitalis Glycosides; Diuretics; Electrocardiography; Heart Auscultation; Heart Failure; Humans; Hyperthyroidism; Male; Mitral Valve Insufficiency; Propylthiouracil; Quinidine; Reserpine; Streptococcal Infections

Topics: Age Factors; Cardiomegaly; Child; Electrocardiography; Female; Heart Auscultation; Heart Failure; Humans; Hyperthyroidism; Prednisone; Propylthiouracil; Recurrence; Remission, Spontaneous; Tachycardia

Topics: Aged; Heart Failure; Humans; Hyponatremia; Hypopituitarism; Male; Myxedema; Propylthiouracil; Triiodothyronine; Vasopressins

Topics: Agranulocytosis; Heart Failure; Hyperthyroidism; Propylthiouracil; Thiouracil; Thyrotoxicosis