Graves’ disease inducing a massive cardiac tamponade

Abstract

A 23-year-old woman was diagnosed with Graves’ disease 5 months ago with decompensated thyroid function, for which she is taking thiamazole and propranolol. She developed progressive respiratory dyspnoea [New York Heart Association (NYHA) class III] and frequent palpitations. On emergency admission, the patient was tachypnoeic, hypotensive (77/54 mm Hg) and tachycardic (120 beats per minute), with an oxygen saturation of 94%. She also presented with cold, swollen and shaky extremities, with extended capillary filling time, and a significant reduction in heart sounds. Echocardiogram showed massive pericardial effusion compatible with cardiac tamponade. Pericardiocentesis was performed, with a drainage of 1420 mL serosanguinolent fluid, with prompt haemodynamic recovery. Analysis of the pericardial fluid showed exudates. A diagnosis of pericardial effusion secondary to Graves’ disease was determined and corticotherapy, lithium carbonate, cholestyramine and phenobarbital were prescribed. An oral iodine-131 was performed and the patient showed reasonable control of the clinical manifestations of hyperthyroidism. After 3 months, the patient showed no symptoms of hyperthyroidism and a new echocardiogram revealed a significant reduction in pericardial effusion.

Serum Levels of CXCL-13, RBP-4, and IL-6, and Correlation Analysis of Patients with Graves’ Disease

“…e reason was analyzed as follows: with the aggravation of the disease, the immune response of the thyroid gland was started, resulting in further imbalance of the immune system in the body and further aggravation of the inflammatory response, inducing the differentiation of a large number of macrophages and nerve cells, and further increasing the level of inflammatory factors. e increased levels of inflammatory factors aggravate the further stimulation and damage of thyroid follicular cells, thereby releasing more thyroid hormones and further enhancing the inflammatory response of the body, forming a vicious circle [23,24].…”