Paradoxical euthyroid hormone profile in a case of Graves' disease with cardiac failure

Abstract

Cardiac failure is an uncommon complication of juvenile hyperthyroidism. We describe an adolescent boy with Graves' disease who developed manifestations of heart failure while on antithyroid medications. There was no evidence of any underlying cardiac disease. He had paradoxical euthyroid hormone profile which rose to hyperthyroid range when the manifestations of the cardiac failure subsided. The case highlights several unusual features of Graves' disease.

Cardiorespiratory Arrest Associated with Propranolol use in Thyrotoxic Heart Disease

“…Increased thyroid hormone activates the renin-angiotensin system and magnifies the sensitivity of beta-adrenergic receptors to catecholamine, which increases left ventricular contractility and heart rate. The activation of the reninangiotensin system also decreases systemic vascular resistance, and increases blood volume [5][6][7]. The chain of reaction subsequently increases myocardial oxygen consumption, cardiac output and cardiac workload [1].…”