An Unusual Case of Hyperthyroidism.

Thyroid gland dysfunction greatly alters the hemodynamics of the body resulting in major changes in cardiac output, blood pressure and pulmonary vascular resistance amongst others. Hyperthyroidism is associated with an increased morbidity and mortality from cardiovascular disease. Thyrotoxicosis is commonly associated with exacerbation of underlying coronary heart disease, with atrial fibrillation and systolic dysfunction. It is less well appreciated that hyperthyroidism is also associated with pulmonary arterial hypertension (PAH) and right heart failure. History -We present a 46 years old female, Presented to our hospital with complaints of Breathlessness on exertion since 3 months gradually progressed from MMRC grade 1 to grade 4 over the period of 2 months without any diurnal/postural variation Cough with expectoration since 3 weeks associated with weight loss. Examination-Patient is severely malnourished with BMI 11.6 kg/m2 . Bilateral multiple cervical lymph nodes palpable, 6-8 in number discrete, mobile, soft consistency, measuring 1 cm in size changes. Thyroid is symmetrically enlarged, soft in consistency, moving with deglutition, Systemic examination-Apex beat palpable at 5th intercostal space 2 cm lateral to the MCL with normal character Parasternal heave grade 3+ Palpable P2+ A high pitched, rumbling, pansystolic murmur of grade 3, non radiating heard best with the diaphragm of stethoscope with patient in supine position. Unique features-Both thyroid lobes appear enlarged in size and show homogeneously increased radiotracer uptake. IMPRESSION- Well-visualized thyroid gland with increased trapping function. In the given clinical context scan findings favour hyperthyroid status-Graves'disease. Take home message-Hyperthyroidism is a reversible cause of pulmonary hypertension.

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© Journal of the Association of Physicians of India 2011.